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

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.

The use of rotational thrombectomy in the treatment of arterial thrombosis

Rotation thrombectomy is a modern method of treating peripheral arterial disease. To date, there are no randomized studies regarding rotational thrombectomy. We want to share our own results in the treatment of patients with arterial thrombosis in the treatment of 8 patients with arteriosclerosis of the lower extremities, complicated by thrombosis using Rotarex. Patients noted the acute onset of the disease, but were referred to the clinic after 2 weeks since the onset of clinical signs of the disease. All patients underwent ultrasound examination, arteriography of the affected arterial segment. After treatment, all patients underwent control angiography. During the procedure, heparin and clopidogrel were administered. One patient had systemic lupus erythematosus. Patients had thrombosis of the femoro-popliteal arterial segments. All patients had a critical ischemia of the lower extremities. Men were 6, women — 2. 2 (25%) of patients had thrombosis of the stent of the superficial femoral artery. In 8 (100%) cases, rotational thrombectomy with rotary catheter was used. For the procedure, catheters with a diameter of 6F and a length of 110–135 cm were used. During the procedure, a catheter was performed from 3 to 5 passages in the affected segment. Duration of the procedure was 1.5–2 hours. In 6 (75%) cases, after the thrombectomy, ballooning of the affected segment was used with a balloon covered with polytaxel. In 8 (100%) patients, there was a clinical improvement. In 8 (100%) patients, control arteriography showed complete patency of the affected segments of the femoral and popliteal arteries. In 8 patients, ischemia was regressed. Cases of rethrombosis were not observed. Thus, rotation thrombectomy is a modern and effective method of treatment of arterial thrombosis of the femoral and popliteal segment.

Midterm Outcomes of Pharmacomechanical Thrombectomy in the Treatment of Lower Extremity Deep Vein Thrombosis With a Rotational Thrombectomy Device

Background: The purpose of this study was to assess the safety and efficacy with midterm outcomes of pharmacomechanical thrombectomy (PMT) performed by using a relatively new thrombectomy device in the treatment of lower extremity deep vein thrombosis (DVT). Methods: Between February 2014 and February 2016, a total of 46 patients with lower extremity DVT were treated with PMT by using Cleaner rotational thrombectomy system. Preprocedural, intraprocedural, postprocedural, and follow-up records of patients were collected and retrospectively analyzed. Results: Mean age of patients was 50.5 (14.8) years, and 58.7% of them were female. Technical success rate of procedure was 91.3%. Mean procedure time was 81.8 (40.3) minutes. Early clinical improvement was observed in all patients with successful treatment. No serious adverse event related to procedure and mortality was observed. Mean follow-up time was 16.0 (7.9) months. Reocclusion was observed in 7 (17.5%) patients during the follow-up period. Venous patency rates of patients at 1-, 3-, 6-, and 12-month follow-up visits were 95%, 92.5%, 89.7%, and 79.5%, respectively. Mild, moderate, and severe postthrombotic syndrome were observed in 8 (20%) patients, 4 (10%) patients, and 1 (2.5%) patient, respectively. Postthrombotic syndrome–free survival rate was 67.5%. Conclusion: Cleaner rotational thrombectomy system appears to be safe and effective in the treatment of lower extremity DVT. Further larger randomized studies are needed to determine the long-term outcomes of this treatment modality.