Interventional radiology management of hemodialysis access-related problems: The use of mechanical thrombectomy devices

Hemodialysis centers are increasingly utilizing the interventional radiologist to manage and treat hemodialysis access-related problems. Using a variety of endovascular tools and techniques, the interventional radiologist can provide several important services for the management of vascular access problems, including: 1) the early detection of stenosis developing within the graft or native veins, 2) the repair of malfunctioning grafts or central venous catheters, and 3) restoration of blood flow to thrombosed hemodialysis grafts. A new type of endovascular tool, the mechanical thrombectomy device, has proven to be useful for quickly and effectively removing thrombus from an acutely occluded vascular access. This article will review the indications for using a mechanical thrombectomy device and describe a variety of the techniques that interventional radiologists use for restoring bloodflow to a thrombosed hemodialysis graft.