scholarly journals THE HYBRID SURGICAL INTERVENTIONS IN PATIENTS WITH CRITICAL ISCHEMIA OF LOWER EXTREMITIES

2017 ◽  
Vol 23 (5) ◽  
pp. 233-236 ◽  
Author(s):  
M. B Temrezov ◽  
Vladimir I. Kovalenko ◽  
R. S Bulgarov ◽  
A. S Bakhmetev ◽  
T. Kh Temrezov ◽  
...  
Keyword(s):  
Clinical Success ◽  
Lower Extremities ◽  
Primary Patency ◽  
Direct Access ◽  
Secondary Patency ◽  
Critical Ischemia ◽  
Severe Condition ◽  
Iliac Arteries ◽  
Surgical Interventions ◽  
Multi Level

The purpose of study is to evaluate efficiency of hybrid surgical interventions under critical anemia of lower extremities in patients with multi-level atherosclerosis affection of arterial bed.The material and methods. The results of surgical treatment using hybrid technology are analyzed. The sampling consisted of 38 patients (33 males and 5 females) suffering from critical anemia of lower extremities because of multi-level atherosclerosis affection of main arteries. The average age was 69,6±2,5 years. The 21 patients (group 1) underwent balloon angioplasty with stenting of iliac arteries through direct access in femoral artery using balloon enlarging stents Asssurant and at the same time instant femoral popliteal stenting. The 17 patients (group 2) underwent stenting of iliac arteries combined with endarterectomy from common and deep arteries of thigh with profundoplastics.The results. The immediate and distant results of treatment in both groups had no differences. After endovascular interventions at iliac segment a primary technical success was achieved in 92.1% of cases and a clinical success - at 81.1% of cases. In the zone of open vascular interventions in femoral popliteal segment primary and secondary patency made up to 89.5% and 97.4% correspondingly. The rate of keeping of extremity in general made up to 92.1% and lethality - 7.9%. The distant results up to three years were monitored in 35 patients. The primary patency in the zone of endovascular intervention after 1, 2 and 3 years made up to 89,8, 76,2 and 68,5% correspondingly. In 5 patients (13.2%) repeated operations were implemented. The level of keeping of extremity after 1,2 and 3 years made up to 77.4%, 74.1% и 72.5%. The survival after 1,2 and 3 years made up to 94,3%, 88,6% and 85,7% correspondingly.The conclusion. The hybrid interventions (stenting of iliac arteries combined with surgical adjustment of femoral popliteal segment) under critical ischemia of lower extremities in the first place are effective and expedient for patients in severe condition and high surgical risk.

scholarly journals Comparative analysis of the surgical treatment results in patients, suffering obliterating atherosclerosis of the lower extremities arteries with multi–level occlusion–stenotic affection on background of critical ischemia

2018 ◽  
Vol 85 (7) ◽  
pp. 34-38
Author(s):  
А. М. Bytsai
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Lower Extremities ◽  
Primary Angioplasty ◽  
Critical Ischemia ◽  
Surgical Interventions ◽  
Type D ◽  
Multi Level ◽  
Peripheral Arterial ◽  
Operation Results

Objective. To improve the results of surgical treatment in patients, suffering obliterating atherosclerosis of the lower extremities (LE) arteries with a multi-level occlusive affection, occurring on background of critical ischemia (CІ). Маterials and methods. The results of surgical treatment of 93 patients, suffering a multi-level occlusive affection of the LE arteries, occurring on background of CІ, performed with obligatory ultradistal restoration of the blood circulation, were analyzed. The main group consisted of 47 (51%) patients, to whom a hemi-open endarterectomy from popliteal artery was performed together with a popliteo-foot autovenous shunting, and a comparison group, consisting of 46 (49%) patients, in whom endovascular angioplasty of popliteo-tibial segment was done. Results. Comparative analysis of the surgical interventions performed have witnessed, that while presence of the Types С and D occlusive-stenotic affections in accordance to classification of Тransatlantic Consensus (TASC II), a choice for open reconstructions must be prioritized, and in a Type В and in some of a Type С observations – a primary angioplasty. When the Type С peculiarities of occlusive affection were revealed, a differentiated approach must be applied while formulating indications for the operation. Results of the interventions performed were followed-up in late period (up to 24 mo). Conclusion. While diagnosis of a Type D occlusion of the shin segment a priority must be referred to operation of a popliteo-foot shunting, and in a Type С – to primary angioplasty, only in presence of diffuse stenotic process without «free» аrterial segment of the foot. Administration of vasostenone promotes effective reduction of peripheral arterial resistance in patients after performance of open surgical intervention as well as in those after angioplasty operation.

Long-term Results with the Palmaz Stent in the Superficial Femoral Artery

1995 ◽  
Vol 2 (2) ◽  
pp. 161-167 ◽  
Author(s):  
Patrice Bergeron ◽  
Jean J. Pinot ◽  
Vincent Poyen ◽  
Huber Benichou ◽  
Patrick Khanoyan ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Primary Patency ◽  
Long Term Results ◽  
Secondary Patency ◽  
Critical Ischemia

Purpose: Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare our experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions. Methods: From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months. Results: In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%. Conclusions: Palmaz stents performed well in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.

Infrainguinal Atherectomy Using the Transluminal Endarterectomy Catheter: Patency Rates and Clinical Success for 144 Procedures

1994 ◽  
Vol 1 (1) ◽  
pp. 61-70 ◽  
Author(s):  
Kenneth A. Myers ◽  
Michael J. Denton ◽  
Terence J. Devine
Keyword(s):  
Patency Rate ◽  
Cox Regression ◽  
Clinical Success ◽  
Balloon Dilation ◽  
Primary Patency ◽  
Secondary Patency ◽  
Open Approach ◽  
Primary Patency Rate ◽  
Critical Ischemia ◽  
Cox Regression Analysis

Purpose: To determine if atherectomy using the transluminal endarterectomy catheter (TEC) is an effective endoluminal therapy for infrainguinal occlusive disease. Methods: Three surgeons used the TEC for 144 infrainguinal atherectomy procedures in 133 patients. The indications were severe claudication in 83, critical ischemia in 56, and graft stenosis in 5 limbs. The pathology was stenosis in 36 and occlusion in 105 limbs. Balloon dilation was also performed in 109 and stenting in 17 limbs. Results: There was initial technical and anatomic success in 124 (86%) procedures. There were 67 technically successful procedures at mean follow-up of 19 months, although 3 of these limbs with gangrene and extensive distal disease required major amputation. There were 26 failures due to stenosis leading to further intervention and 51 due to occlusion. Twenty of these cases were managed conservatively, 21 were treated with repeat endovascular intervention, 31 with bypass grafting, and 5 with amputation. Repeat intervention in 52 limbs resulted in 36 with patent arteries, 10that are occluded, and 6that required amputation. Thirteen of the 14 amputations were for limbs with critical ischemia, but 1 was in a patient with claudication. Life-table analysis showed that the primary patency rate was 51%, the assisted primary patency rate was 61%, and the secondary patency rate was 75% at 15 months. The clinical success rate was 49%, and the salvage rate for limbs with critical ischemia was 78% at 12 months. Univariate log-rank testing showed no significant differences according to the clinical presentation or pathology, but results were worse for lesions > 5 cm long due to more frequent immediate failures. However, multivariate Cox regression analysis showed that results were significantly worse for critical ischemia than for claudication, stenosis compared to occlusions, for limbs with poor runoff, for operations performed by percutaneous rather than an open approach, and for those performed more recently. Conclusions: TEC atherectomy may have a place in selected patients, but the optimal circumstances for its use and long-term efficacy require further study.

The usefulness and feasibility of placing a clinch knot with a guidewire to achieve temporary hemostasis in arteriovenous dialysis access interventions

2020 ◽  
pp. 112972982095474
Author(s):  
Sung-Joon Park ◽  
Hwan Hoon Chung ◽  
Seung Hwa Lee ◽  
Sung Beom Cho ◽  
Tae-Seok Seo ◽  
...  
Keyword(s):  
Clinical Success ◽  
Primary Patency ◽  
Interventional Treatment ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Hemodialysis Access ◽  
Purse String Suture ◽  
Purse String ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Grafts

Purpose: To evaluate the usefulness and feasibility of using a reversible clinch knot with a guidewire in place rather than eliminating the access route during an arteriovenous hemodialysis access (AV access) intervention using the facing sheath technique. Material and methods: From July 2016 to June 2019, we retrospectively studied 78 sessions performed as interventional treatment for arteriovenous (AV) hemodialysis (HD) access using the “facing-sheath technique.” In all sessions, all antegrade sheaths were removed while a 0.035-inch guidewire remained in place with purse-string suture and the clinch knot. Seventy-two sessions were performed in patients with thrombosed AV accesses (69 arteriovenous grafts [AVGs] and three arteriovenous fistulas [AVFs]), and six sessions were carried out to treat non-thrombosed AV accesses (four AVGs and two AVFs). We evaluated whether proper hemostasis and successful reinsertion of the sheath over the wire into the clinch knot was achieved. Clinical success was defined as achieving prompt restoration of blood flow for AV access, and the postintervention primary and secondary patency were also evaluated. Result: In all 87 clinch knots created in 78 total sessions, proper hemostasis was achieved. All clinch knots that required reversal for additional procedures were successfully reopened (55 clinch knots in 50 sessions). The postintervention primary patency rates at 1, 3, and 6 months, and at 1 year were 77.8%, 68.9%, 55.6%, and 33.3%, respectively. The postintervention secondary patency rates at 1, 3, and 6 months, and also at 1 year were 93.3%, 91.1%, 86.7%, and 86.7%, respectively. Conclusion: Our AV access intervention which used a clinch knot with purse-string suture while the guidewire remained in place was both useful and feasible for maintaining temporary hemostasis.

scholarly journals HYBRID INTERVENTIONS IN EMERGENCY ANGIOSURGERY

2021 ◽  
Vol 29 (2) ◽  
pp. 250-256
Author(s):  
S.V. Mshar ◽  
◽  
V.N. Zasimovich ◽  
V.A. Asanovich ◽  
E.Ya. Nikolenko ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Perioperative Complications ◽  
Ankle Brachial Index ◽  
Lower Extremities ◽  
Primary Patency ◽  
Complete Revascularization ◽  
Type B ◽  
Hybrid Surgery ◽  
Surgical Interventions ◽  
Results Of Treatment

Objective. To improve the results of treatment of patients with multilevel atherosclerotic lesions and aortic dissection. Methods. In 2019 year 16 hybrid surgical interventions on arteries of lower extremities and 1 hybrid intervention for aortic dissection type B were made in Brest Regional Hospital. Most of the patients were men (15 out of 16), the average age was 60.2±6.4 (M±σ) years. Disease was staged according to the Fontaine-Pokrovsky classification: 4 patients (25%) - IIb, 8 (25%) - III, 4 (25%) - IV. The type of surgery was determined by the level of occlusion / stenosis (according to Doppler ultrasound and angiographic examination) and the state of the outflow tract. According to the TASC II classification, all patients were class C or D. Four groups of hybrid interventions on the arteries of the lower extremities were identified: hybrid on the ilio-femoral segment (n=9), hybrid on the femoral-popliteal segment (n=4), hybrid on the femoral segment (n=1), hybrid on the aorto-iliac segment (n=2). Results. Technical success was achieved in 100% of cases. In 1 case thrombosis of the superficial femoral artery occurred, which did not require reconstruction due to compensated collateral blood flow, and 1 case of death from acute heart failure. Primary patency was achieved in 93.75% of cases. Duration of hybrid surgery 174.2±67.3 (M±σ) min. Duration of the open stage of the operation - 72.85±30.3 (M±σ) min. The augmentation of the ankle-brachial index (ABI) was 0.26±0.15 (M±σ). Hybrid interventions were performed in the X-ray operating room and always from one vascular access. The amount of iodine-contrasting substance used is 150.8±68 (M±σ) ml. Conclusion. The use of hybrid interventions provides complete revascularization of lower extremities and minimizes risks of perioperative complications during implantation of aortic stent grafts in type B aortic dissection. Hybrid operations should be considered as the most perspective direction in the development of angiosurgery.

Thrombosed native hemodialysis fistulas: Technical and clinical outcomes of endovascular recanalization and factors influencing patency

2019 ◽  
Vol 20 (6) ◽  
pp. 725-732 ◽  
Author(s):  
Young Ho So ◽  
Young Ho Choi ◽  
Sohee Oh ◽  
In Mok Jung ◽  
Jung Kee Chung ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Proportional Hazards Model ◽  
Clinical Success ◽  
Clinical Results ◽  
Primary Patency ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Secondary Patency ◽  
Endovascular Recanalization ◽  
Factors Influencing

Purpose: To evaluate the technical and clinical results of endovascular recanalization of thrombosed native hemodialysis fistula and the factors influencing patency. Methods: A retrospective study was conducted with 73 patients who had thrombosed arteriovenous fistulas and were treated with endovascular methods. Patient characteristics, arteriovenous fistula-related characteristics, and endovascular procedures were analyzed. Technical and clinical results and patency rates were evaluated. The factors influencing patency were analyzed using a univariate and multivariate Cox proportional hazards model. Results: Technical and clinical success rates were 93% (68/73) and 85% (62/73), respectively. At 3, 6, and 12 months, the primary patency rates were 87.9%, 73.3%, and 64.8%; assisted primary patency rates were 89.2%, 78.6%, and 70.7%; and secondary patency rates were 90.8%, 87.2%, and 83.1%, respectively. Previous intervention and cephalic arch stenosis were risk factors for lower primary and assisted primary patency ( p < 0.05 for all). Cephalic arch stenosis was the only risk factor for lower secondary patency ( p < 0.05). No major complications associated with the procedures were noticed. Conclusion: Endovascular treatment was effective for the immediate recanalization of thrombosed arteriovenous fistula. In addition, previous intervention and cephalic arch stenosis were significantly related to lower arteriovenous fistula patency.

P1329STENTING VERSUS ISOLATED BALLOON ANGIOPLASTY FOR CENTRAL VEIN STENOSIS IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Aleksei Zulkarnaev ◽  
Zurab Kardanakhishvili ◽  
Boris Baykov
Keyword(s):  
Balloon Angioplasty ◽  
Primary Patency ◽  
Endovascular Intervention ◽  
Time Interval ◽  
Central Vein ◽  
Secondary Patency ◽  
Surgical Interventions ◽  
Endovascular Interventions ◽  
Vein Stenosis ◽  
Central Vein Stenosis

Abstract Background and Aims comparative analysis of the results of isolated balloon angioplasty (BA) and BA with stenting of central veins stenosis in patients on hemodialysis. Method A retrospective study included 62 patients with confirmed stenosis of the central veins: subclavian, brachiocephalic veins, vena cava inferior, or multiple lesions. In 39 patients, stents are not used; isolated balloon angioplasty (BA) was performed. In 23 patients we used bare metal stents. Results Functional primary patency (the time interval between the start of AVF using and the first endovascular intervention) did not differ in the groups – fig. 1A; HR 1.142 [95% CI 0.6875; 1.897], p = 0.5994. The use of stents leads to increase primary patency (the time interval between the first and second endovascular interventions) – fig. 1B; HR 2.064 [95% CI 1.252; 3.404], p = 0.0017. The use of stents allows to increase the functional secondary patency (total duration of use of the AVF) – fig 1C; HR 2.099 [95% CI 1.272; 3.463], p = 0.0016. Secondary patency (the time interval between the first endovascular intervention and the complete cessation of the use of AVF) was higher after BA with stenting: HR 2.03 [95% CI 1.232; 3.347], p = 0.0021; fig 1D. The use of stents allows to increase functional primary assisted patency (non-occlusive period from the start of AVF use) – fig. 1E and primary assisted patency (non-occlusive period from the first surgical intervention) – fig 1F: HR 1.936 [95% CI 1.175; 3.188], p= 0.0053 and HR 2.0 [95% CI 1.213; 3.295], p = 0.0042. The need for open reconstructive interventions after the first BA or BA with stenting was the same 0.374 [95% CI 0.24; 0.556] and 0.45 [95% CI 0.291; 0.664] per 10 patient-months, incidence rate ratio (IRR)= 0.831 [95% CI 0.471; 1.464] р=0.521. The need for endovascular interventions did not differ between isolated BA and BA with stenting 1.137 [95% CI 0.8913; 1.43] and 0.827 [95% CI 0.606; 1.104] per 10 patient-months, IRR=1.374 [95% CI 0.952; 1.999] p=0.09. Total need for surgical interventions (open + endovascular) also did not differ: 1.511 [95% CI 1.225; 1.843] and 1.277 [95% CI 0.997; 1.611] per 10 patient-months, IRR 1.183 [95% CI 0.872; 1.612] p=0.2822. We found a strong negative correlation between functional primary patency and primary patency (r = -0.627; p &lt;0.0001) – fig. 2, as well as a between functional primary patency and secondary patency in patients after isolated BA (= -0.53; p = 0.0005, respectively), but not after stenting (r = -0.351; p = 0.101 and r = -0.304; p = 0.159, respectively). In a case of isolated BA, the success of the first intervention largely determines the secondary patency, which is expressed in a strong, statistically significant positive correlation of primary patency and secondary patency. In a case of BA with stenting, the correlation between these estimates is also statistically significant, but significantly lower. Conclusion 1. The results of balloon angioplasty without stenting are significantly influenced by the duration of the period between the start of AVF use and the manifestation of central vein stenosis. 2. The use of stents can slightly improve the results of endovascular interventions in central vein stenosis, regardless the its time of development. 3. The use of stents leads to a moderate increase in the median patency of AVF and a significant increase in the proportion of patients with functional AVF in the late postoperative period. 4. The use of stents does not reduce the need for surgical interventions

scholarly journals Treatment of critical limb ischemia in patients with multilevel arterial lesions

2018 ◽  
Vol 22 (3) ◽  
pp. 474-478
Author(s):  
V. Shaprynskyi ◽  
Y. Gupalo ◽  
O. Shved ◽  
O. Nabolotnyi ◽  
D. Shapovalov
Keyword(s):  
Atherosclerotic Lesion ◽  
Lower Extremities ◽  
Main Group ◽  
Lower Limbs ◽  
Control Group ◽  
Critical Ischemia ◽  
Optimal Method ◽  
Surgical Interventions ◽  
Limb Preservation ◽  
Arterial Lesions

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

Vacuum-assisted mechanical thrombectomy in extensively occlusive thrombosis of dialysis arteriovenous grafts with indigo system

2020 ◽  
Vol 21 (5) ◽  
pp. 673-679
Author(s):  
Filippo Piacentino ◽  
Andrea Coppola ◽  
Andrea Zaghetto ◽  
Edoardo Macchi ◽  
Giuseppe De Marchi ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Clinical Success ◽  
Primary Patency ◽  
Secondary Patency ◽  
Technical Failure ◽  
Arteriovenous Graft ◽  
Venous Outflow ◽  
Percutaneous Mechanical Thrombectomy ◽  
Arterial Inflow ◽  
Surgical Thrombectomy

Purpose: To present a selected series of extensively occlusive thrombosis of arteriovenous graft treated with the Penumbra’s Indigo System. Materials and Methods: Ten patients with acute (within 72 h) extensively occlusive thrombosis of arteriovenous graft (mean extension = 30.1 (range = 15–45) cm) were treated at our institution with the Indigo System. Of the 10 cases, thrombosis was extended to venous outflow in 7 cases and to both arterial inflow and venous outflow in 3 cases. Results: Both anatomic and clinical success were achieved in 8 of the 10 procedures (80.0%). In the 2 cases of technical failure, the patients underwent surgical thrombectomy with the finding of arteriovenous graft exhaustion, which was then replaced. The 6-month primary patency, primary-assisted patency, and secondary patency rates were 37.5% (3/8), 50.0% (4/8), and 62.5% (5/8). We reported 2 complications (one minor and one major adverse event). Conclusion: Percutaneous mechanical thrombectomy aspiration with Indigo System is a relatively safe and effective procedure and can be used even in extensively thrombosed arteriovenous graft.

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

2021 ◽  
pp. 112972982110609
Author(s):  
Cheryl Lim ◽  
Justin Kwan ◽  
Zhiwen Joseph Lo ◽  
Qiantai Hong ◽  
Li Zhang ◽  
...  
Keyword(s):  
Vascular Access ◽  
Clinical Success ◽  
Clinical Success Rate ◽  
Primary Patency ◽  
Secondary Patency ◽  
Complication Rates ◽  
Single Session ◽  
Arteriovenous Fistulas ◽  
Rotational Thrombectomy ◽  
Thrombectomy Device

Objectives: This paper documents our experience and outcomes of using a relatively new endovascular rotational thrombectomy device for salvage of thrombosed vascular access. Methodology: A retrospective study reviewing patients with thrombosed native AVF or AVG who underwent endovascular declotting using a rotational thrombectomy device between November 2018 and May 2020 at a tertiary university hospital in Southeast Asia. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: A total of 40 patients underwent single session endovascular declotting of thrombosed vascular access. The mean follow-up period was 21.6 months (range 13.4–31 months). The technical success was 92.5% and clinical success was 80%. About 50% of patients had concomitant thrombolysis for pharmacomechanical thrombectomy. One patient had a myocardial infarction during the post-operative period. There were no other major complications within 30 days. The primary patency was 45.5% at 6 months and 22.7% at 12 months. Assisted primary patency was 68.1% at 6 months and 61.6% at 12 months, which was maintained up to 2 years. The secondary patency was 84.1% at 6 and 12 months. Conclusion: Our study shows that rotational thrombectomy device for single session thrombectomy of thrombosed arteriovenous fistulas and grafts is safe and effective. A high technical and clinical success rate was achieved, with low complication rates and specific advantages compared to other techniques, including reduced length of hospital stay. Our reported mid-term outcomes are reasonable with an assisted primary patency of 62% at 12 and 24 months. The use of newer techniques and novel dedicated thrombectomy devices show promise.

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