The Cleaner XT™ Device as an Endovascular Adjunct for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Fistulas and Grafts

Objective: This paper documents our experience using the Cleaner XT (TM) device (Argon Medical Devices, Plano, TX, USA) for pharmacomechanical thrombolysis (PMT) of thrombosed haemodialysis arteriovenous grafts (AVG) and fistulas (AVF). Materials and Methods: This was a retrospective case series (n= 17) over six months at Singapore General Hospital. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: There were 8 (47%) males and the patients' mean age was 66 (+/- 5.7) years. The mean age of AVF/AVG was 1605 (+/- 1099) days. All procedures were performed under local anaesthetic. PMT was performed within a mean time of 40 (+/- 34.3) hours from the presentation. Technical, clinical and procedural success was 15/17 (88%). The thrombolysis agents used were tissue plasminogen activator (52.9%) and urokinase (41.2%). Mean primary patency time was 114 (+/- 116) days, with a 65% 1-month and 47% 3-month primary patency rates. The mean secondary patency time was 155 (+/- 132) days, with 76% one-month and 65% threemonth secondary patency rates, respectively. AVF rupture occurred in 3/17 (18%) cases but did not involve loss of the access circuit. Conclusion: The Cleaner XT (TM) device is a safe, minimally invasive endovascular tool for PMT in thrombosed AVF/AVG, with relatively high success and low complication rates.