Skip to main content
Top
Published in: CardioVascular and Interventional Radiology 10/2016

01-10-2016 | Technical Note

Aspirex Thrombectomy in Occluded Dialysis Access: A Retrospective Study

Authors: Jules Dyer, Joao Rosa, Menka Chachlani, Johann Nicholas

Published in: CardioVascular and Interventional Radiology | Issue 10/2016

Login to get access

Abstract

Purpose

This study is the first to present the outcomes of the Straub Aspirex device for the salvage of occluded renal dialysis access fistulae.

Materials and Methods

This is a retrospective study, using data from the Renal Unit and Radiology Department database. It included all the patients between 2010 and 2014 who underwent percutaneous mechanical thrombectomy (PMT) treated by JD. Aspirex is an over-the-wire, 6–10 French catheter within which is a rapidly rotating helix which draws thrombus into a window near the tip which it then macerates and removes. Access survival was assessed using the Kaplan–Meier method, and multi-variant analysis was performed using the Cox proportional hazards model. Significance was considered if p < 0.05.

Results

A total of 27 procedures were performed for 19 patients. 13 had autologous arterio-venous fistulae, and 14 had synthetic (PTFE) arterio-venous grafts. 15 were males, 4 females. 100 % of the patients successfully had a channel of thrombus removed. This resulted in an 81.5 % initial clinical success, with primary patency rates of 53.6, 44.3 and 33 % by days 30, 90 and 480, respectively, without significant difference of any analysed covariates. No major complication (pulmonary embolus, paradoxical cerebral infarction, limb ischaemia or significant haemorrhage) occurred.

Conclusion

Aspirex has rates of patency and complication similar to other PMT devices. No covariant studied affected outcome.
Literature
1.
go back to reference Sands JJ, Jabyac PA, Miranda CL, Kapsick BJ. Intervention based on monthly monitoring decreases hemodialysis access thrombosis. ASAIO J Am Soc Artif Int Organs. 1999;45(3):147–50.CrossRef Sands JJ, Jabyac PA, Miranda CL, Kapsick BJ. Intervention based on monthly monitoring decreases hemodialysis access thrombosis. ASAIO J Am Soc Artif Int Organs. 1999;45(3):147–50.CrossRef
2.
go back to reference Littler P, Cullen N, Gould D, Bakran A, Powell S. AngioJet thrombectomy for occluded dialysis fistulae: outcome data. Cardiovasc Interv Radiol. 2009;32(2):265–70.CrossRef Littler P, Cullen N, Gould D, Bakran A, Powell S. AngioJet thrombectomy for occluded dialysis fistulae: outcome data. Cardiovasc Interv Radiol. 2009;32(2):265–70.CrossRef
3.
go back to reference Yang C-C, Yang C-W, Wen S-C, Wu C-C. Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2012;80(6):1035–41.CrossRef Yang C-C, Yang C-W, Wen S-C, Wu C-C. Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2012;80(6):1035–41.CrossRef
4.
go back to reference Uflacker R, Rajagopalan PR, Selby JB, Hannegan C. Investigators of the Clinical Trial Sponsored by Microvena Corporation. Thrombosed dialysis access grafts: randomized comparison of the Amplatz thrombectomy device and surgical thromboembolectomy. Eur Radiol. 2004;14(11):2009–14.CrossRefPubMed Uflacker R, Rajagopalan PR, Selby JB, Hannegan C. Investigators of the Clinical Trial Sponsored by Microvena Corporation. Thrombosed dialysis access grafts: randomized comparison of the Amplatz thrombectomy device and surgical thromboembolectomy. Eur Radiol. 2004;14(11):2009–14.CrossRefPubMed
5.
go back to reference Vesely TM, Williams D, Weiss M, Hicks M, Stainken B, Matalon T, et al. Comparison of the angiojet rheolytic catheter to surgical thrombectomy for the treatment of thrombosed hemodialysis grafts. Peripheral Angio Jet Clinical Trial J Vasc Interv Radiol JVIR. 1999;10(9):1195–205.CrossRef Vesely TM, Williams D, Weiss M, Hicks M, Stainken B, Matalon T, et al. Comparison of the angiojet rheolytic catheter to surgical thrombectomy for the treatment of thrombosed hemodialysis grafts. Peripheral Angio Jet Clinical Trial J Vasc Interv Radiol JVIR. 1999;10(9):1195–205.CrossRef
6.
go back to reference Shatsky JB, Berns JS, Clark TWI, Kwak A, Tuite CM, Shlansky-Goldberg RD, et al. Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol JVIR. 2005;16(12):1605–11.CrossRefPubMed Shatsky JB, Berns JS, Clark TWI, Kwak A, Tuite CM, Shlansky-Goldberg RD, et al. Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol JVIR. 2005;16(12):1605–11.CrossRefPubMed
8.
9.
go back to reference Eid-Lidt G, Gaspar J, Sandoval J, de los Santos FD, Pulido T, Pacheco HG, et al. Combined clot fragmentation and aspiration in patients with acute pulmonary embolism. Chest. 2008;134(1):54–60.CrossRefPubMed Eid-Lidt G, Gaspar J, Sandoval J, de los Santos FD, Pulido T, Pacheco HG, et al. Combined clot fragmentation and aspiration in patients with acute pulmonary embolism. Chest. 2008;134(1):54–60.CrossRefPubMed
10.
go back to reference Bayiz H, Dumantepe M, Teymen B, Uyar I. Percutaneous aspiration thrombectomy in treatment of massive pulmonary embolism. Heart Lung Circ. 2015;24(1):46–54.CrossRefPubMed Bayiz H, Dumantepe M, Teymen B, Uyar I. Percutaneous aspiration thrombectomy in treatment of massive pulmonary embolism. Heart Lung Circ. 2015;24(1):46–54.CrossRefPubMed
11.
go back to reference Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788–830.CrossRefPubMed Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123(16):1788–830.CrossRefPubMed
12.
go back to reference Kwan J, Pua U. Aspirex S catheter malfunction during arteriovenous fistula thrombectomy secondary to a jammed helix-guidewire complex. J Endovasc Ther Off J Int Soc Endovasc Spec. 2014;21(5):755–9. Kwan J, Pua U. Aspirex S catheter malfunction during arteriovenous fistula thrombectomy secondary to a jammed helix-guidewire complex. J Endovasc Ther Off J Int Soc Endovasc Spec. 2014;21(5):755–9.
13.
go back to reference Tapping CR, Mallinson PI, Scott PM, Robinson GJ, Lakshiminarayan R, Ettles DF. Clinical outcomes following endovascular treatment of the Malfunctioning autologous dialysis fistula. J Med Imaging Radiat Oncol. 2010;54(6):534–40.CrossRefPubMed Tapping CR, Mallinson PI, Scott PM, Robinson GJ, Lakshiminarayan R, Ettles DF. Clinical outcomes following endovascular treatment of the Malfunctioning autologous dialysis fistula. J Med Imaging Radiat Oncol. 2010;54(6):534–40.CrossRefPubMed
14.
go back to reference Gray RJ, Sacks D, Martin LG, Trerotola SO. Reporting standards for percutaneous interventions in dialysis access. J Vasc Interv Radiol 2003;14(9 Pt 2):S433–42.CrossRef Gray RJ, Sacks D, Martin LG, Trerotola SO. Reporting standards for percutaneous interventions in dialysis access. J Vasc Interv Radiol 2003;14(9 Pt 2):S433–42.CrossRef
15.
go back to reference Krivitski NM. Theory and validation of access flow measurement by dilution technique during hemodialysis. Kidney Int. 1995;48(1):244–50.CrossRefPubMed Krivitski NM. Theory and validation of access flow measurement by dilution technique during hemodialysis. Kidney Int. 1995;48(1):244–50.CrossRefPubMed
16.
go back to reference Bentaarit B, Duval AM, Maraval A, Dahmane D, Dahan K, Amara B, Lang P, Sahali D. Paradoxical embolism following thromboaspiration of an arteriovenous fistula thrombosis: a case report. J Med Case Rep. 2010;28(4):345. doi:10.1186/1752-1947-4-345.CrossRef Bentaarit B, Duval AM, Maraval A, Dahmane D, Dahan K, Amara B, Lang P, Sahali D. Paradoxical embolism following thromboaspiration of an arteriovenous fistula thrombosis: a case report. J Med Case Rep. 2010;28(4):345. doi:10.​1186/​1752-1947-4-345.CrossRef
17.
go back to reference Calderon K, Jhaveri KD, Mossey R. Pulmonary Embolism following Thrombolysis of Dialysis Access: Is anticoagulation necessary? Semin Dial. 2010;23(5):522–5.CrossRefPubMed Calderon K, Jhaveri KD, Mossey R. Pulmonary Embolism following Thrombolysis of Dialysis Access: Is anticoagulation necessary? Semin Dial. 2010;23(5):522–5.CrossRefPubMed
18.
go back to reference Swan TL. SmythSH, Riffnach SJ. Pulmonary embolism after thrombolysis of haemodialysis grafts J Vasc Interv Rad. 1995;6(5):683–6. Swan TL. SmythSH, Riffnach SJ. Pulmonary embolism after thrombolysis of haemodialysis grafts J Vasc Interv Rad. 1995;6(5):683–6.
19.
go back to reference Smits HF, Van Rijk PP, Van Isselt JW. Pulmonary embolism after thrombosis of haemodialysis grafts. J Am Soc Nephrol. 1997;8(9):1458–61.PubMed Smits HF, Van Rijk PP, Van Isselt JW. Pulmonary embolism after thrombosis of haemodialysis grafts. J Am Soc Nephrol. 1997;8(9):1458–61.PubMed
20.
go back to reference Vorwerk D. Complications in the percutaneous management of failing haemodialysis fistulas and grafts, Chapter 14. In: Schillinger M, Minar E, editors. Complications in peripheral vascular interventions; 2007. Vorwerk D. Complications in the percutaneous management of failing haemodialysis fistulas and grafts, Chapter 14. In: Schillinger M, Minar E, editors. Complications in peripheral vascular interventions; 2007.
21.
go back to reference Trerotola SO, Johnson MS, Shauwecker DS. Pulmonary embolism from pulse spray and mechanical thrombolysis; evaluation with an animal dialysis-graft model. Radiology. 1996;200(1):169–76.CrossRefPubMed Trerotola SO, Johnson MS, Shauwecker DS. Pulmonary embolism from pulse spray and mechanical thrombolysis; evaluation with an animal dialysis-graft model. Radiology. 1996;200(1):169–76.CrossRefPubMed
Metadata
Title
Aspirex Thrombectomy in Occluded Dialysis Access: A Retrospective Study
Authors
Jules Dyer
Joao Rosa
Menka Chachlani
Johann Nicholas
Publication date
01-10-2016
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 10/2016
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-016-1351-0

Other articles of this Issue 10/2016

CardioVascular and Interventional Radiology 10/2016 Go to the issue