Percutaneous thrombolysis of thrombosed haemodialysis access grafts:: comparison of three mechanical devices

Background. Percutaneous thrombolysis has become an accepted treatment of thrombosed haemodialysis grafts. Several devices have been developed for mechanical thrombolysis, which macerate the clot using different mechanisms such as aspiration and fragmentation. The aim of our study was to compare the efficacy of three devices for mechanical thrombolysis in removing the thrombus from thrombosed haemodialysis access grafts and to determine the initial technical and clinical success, complication rates of each device, and graft patency after the procedure. Methods. Thrombolysis (i.e. clot removal followed by percutaneous transluminal angioplasty (PTA)) was performed in 68 thrombosed haemodialysis grafts using the Cragg brush catheter combined with urokinase in 13, the Hydrolyser in 18 and the Arrow-Trerotola Percutaneous Thrombolytic Device (PTD) in 37. Clot removal scores (CRS, the ability to thoroughly remove clot from the access), initial technical success, clinical success, patency at 30, 60, and 90 days, and complication rates were evaluated. Results. CRS for the Cragg brush, Hydrolyser and PTD were good in 92, 44, and 95% of cases, respectively. Initial technical (85, 83, and 95%) and clinical success (62, 67, and 86%), mean patency rates at 30 (73, 60, and 55%), 60 (61, 53, and 49%), and 90 (49, 40, and 43%) days, stenosis after PTA (33, 46, and 21%) and complication rates (8, 6, and 0%) were not different for the three devices. Success rates and graft patency depended on the effect of PTA, irrespective of the device used. Conclusions. The rotational devices removed clots more effectively than the Hydrolyser, with the PTD having the advantage of not requiring urokinase. However, the result of PTA in the treatment of underlying stenoses was the only predictive value for graft patency.