Fogarty balloon catheter embolectomy for arteriovenous graft thrombosis in hemodialysis patients: an analysis of outcomes_West China Medical Journal

Authors：

ZHANG Wanjun ,  MEI Lan , LIU Bijian , WANG Gang , LIU Huixi , CAI Yu , JIA Xiaodan

Department of Blood Purification, No. 202 Hospital of PLA, Shenyang, Liaoning 110003, P. R. China;

Corresponding author：

MEI Lan, Email: 42954900@qq.com

Keywords：

Fogarty balloon catheter; Thrombosis; Arteriovenous graft; Hemodialysis

DOI：

10.7507/1002-0179.201511173

Video：

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Objective To evaluate the effect of Fogarty balloon catheter embolectomy on arteriovenous graft thrombosis in hemodialysis patients. Methods We retrospectively analyzed the clinical data of 11 patients who underwent maintaining hemodialysis and arteriovenous graft thrombosis through Fogarty balloon catheter embolectomy between March 2010 and November 2014. The thrombosed graft was incised, and a 4 or 6 French catheter was placed in the venous and arterial limbs of the graft respectively. The Fogarty balloon was passed beyond the thrombus and pulled out after saline was infused into the balloon, and the thrombus was taken out. The procedure was considered unsuccessful if the blood flow was not re-established or if the graft re-thrombosed within hours. Results The treatment was successfully performed in all the patients. Of the 11 patients, 3 received balloon dilation due to stenosis of venous anastomosis, and 2 received angioplasty due to underlying arterial anastomosis lesion. After corresponding measures were taken, the thrombus of all the 11 patients were taken out, and blood flow was recovered. Two to seven days after surgery, low molecular weight heparin was used for anti-coagulation. The blood flow of all arteriovenous grafts reached over 250 mL/min. All the patients were followed up for 4 to 30 months. During the follow-up, the arteriovenous graft remained functional in 5 patients; 4 patients had re-thrombosis on day 2, 3, 25, and 71 after surgery respectively; one changed to undergo peritoneal dialysis due to rupture and infection of the graft, and one patient was transferred to another hospital in another area and was not followed up any longer. The therapy was successful in 81.8% of this group of patients. Conclusion Fogarty balloon catheter embolectomy is effective in restoring patency of thrombosed arteriovenous graft in hemodialysis patients, and more studies are needed.

Citation： ZHANGWanjun, MEILan, LIUBijian, WANGGang, LIUHuixi, CAIYu, JIAXiaodan. Fogarty balloon catheter embolectomy for arteriovenous graft thrombosis in hemodialysis patients: an analysis of outcomes. West China Medical Journal, 2017, 32(2): 182-185. doi: 10.7507/1002-0179.201511173 Copy

1.	伍强, 杨铁城, 孙艳, 等. Fogarty 导管取栓术在人造血管动静脉内瘘血栓形成的应用. 中国中西医结合肾病杂志, 2010, 11(4): 342-343.
2.	徐政全, 陶建萍. 血液透析患者动静脉内瘘闭塞原因分析及预防措施. 现代中西医结合杂志, 2008, 8(5): 124-125.
3.	张文贤, 张训. 血液透析患者血管通路血栓形成影响因素的分析. 中华肾脏病杂志, 2002, 18(3): 221-222.
4.	孙琳琳, 叶朝阳, 张玉强, 等. Fogarty 球囊导管取栓术在动静脉内瘘失功中的应用. 第二军医大学学报, 2007, 28(6): 674.
5.	Wish JB. Vascular access for dialysis in the United States: progress, hurdles, controversies, and the future. Semin Dial, 2010, 23(6): 614-618.
6.	Besarab A. Resolved: fistulas are preferred to grafts as initial vascular access for dialysis. pro. J Am Soc Nephrol, 2008, 19(9): 1629-1631.
7.	Vazquez A. Vascular access for dialysis: recent lessons and new insights. Curr Opin Nephrol Hypertens, 2009, 18(2): 116-121.
8.	Lee T, Allon M. Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula. J Am Soc Nephrol, 2007, 18(6): 1936-1941.
9.	Leermakers JJ, Bode AS, Vaidya A,et al. Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulasversus arteriovenous grafts. Eur J Vasc Endovasc Surg, 2013, 45(1): 84-92.
10.	Shingarev R, Maya D, Barker-Finkel J,et al. Arteriovenous graft placement in predialysis patients: a potential catheter-sparing strategy. Am J Kidney Dis, 2011, 58(2): 243-247.
11.	Asif A, Leclercq B, Merrill D,et al.Arteriovenous fistula creation: should US nephrologists get involved?. Am J Kidney Dis, 2003, 42(6): 1293-1300.
12.	叶朝阳, 赵久阳, 陆石, 等. 血液透析血管通路技术与临床应用. 2版. 上海: 复旦大学出版社, 2010: 94.
13.	Maya D, Smith T, Young J,et al. Is surgical salvage of arteriovenous grafts feasible after unsuccessful percutaneous mechanical thrombectomy?. Semin Dial, 2008, 21(2): 174-177.
14.	Maya D, Allon M. Outcomes of thrombosed arteriovenous grafts: comparison of stentsvs angioplasty. Kidney Int, 2006, 69(5): 934-937.
15.	Manousaki E, Tsetis D, Kostas T,et al. Endovascular treatment of a ruptured profunda femoral artery branch after fogarty thrombectomy of a femoro-femoral crossover arterial graft: a case report and review of the literature. Cardiovasc Intervent Radiol, 2010, 33(1): 182-186.

1. 伍强, 杨铁城, 孙艳, 等. Fogarty 导管取栓术在人造血管动静脉内瘘血栓形成的应用. 中国中西医结合肾病杂志, 2010, 11(4): 342-343.
2. 徐政全, 陶建萍. 血液透析患者动静脉内瘘闭塞原因分析及预防措施. 现代中西医结合杂志, 2008, 8(5): 124-125.
3. 张文贤, 张训. 血液透析患者血管通路血栓形成影响因素的分析. 中华肾脏病杂志, 2002, 18(3): 221-222.
4. 孙琳琳, 叶朝阳, 张玉强, 等. Fogarty 球囊导管取栓术在动静脉内瘘失功中的应用. 第二军医大学学报, 2007, 28(6): 674.
5. Wish JB. Vascular access for dialysis in the United States: progress, hurdles, controversies, and the future. Semin Dial, 2010, 23(6): 614-618.
6. Besarab A. Resolved: fistulas are preferred to grafts as initial vascular access for dialysis. pro. J Am Soc Nephrol, 2008, 19(9): 1629-1631.
7. Vazquez A. Vascular access for dialysis: recent lessons and new insights. Curr Opin Nephrol Hypertens, 2009, 18(2): 116-121.
8. Lee T, Allon M. Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula. J Am Soc Nephrol, 2007, 18(6): 1936-1941.
9. Leermakers JJ, Bode AS, Vaidya A,et al. Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulasversus arteriovenous grafts. Eur J Vasc Endovasc Surg, 2013, 45(1): 84-92.
10. Shingarev R, Maya D, Barker-Finkel J,et al. Arteriovenous graft placement in predialysis patients: a potential catheter-sparing strategy. Am J Kidney Dis, 2011, 58(2): 243-247.
11. Asif A, Leclercq B, Merrill D,et al.Arteriovenous fistula creation: should US nephrologists get involved?. Am J Kidney Dis, 2003, 42(6): 1293-1300.
12. 叶朝阳, 赵久阳, 陆石, 等. 血液透析血管通路技术与临床应用. 2版. 上海: 复旦大学出版社, 2010: 94.
13. Maya D, Smith T, Young J,et al. Is surgical salvage of arteriovenous grafts feasible after unsuccessful percutaneous mechanical thrombectomy?. Semin Dial, 2008, 21(2): 174-177.
14. Maya D, Allon M. Outcomes of thrombosed arteriovenous grafts: comparison of stentsvs angioplasty. Kidney Int, 2006, 69(5): 934-937.
15. Manousaki E, Tsetis D, Kostas T,et al. Endovascular treatment of a ruptured profunda femoral artery branch after fogarty thrombectomy of a femoro-femoral crossover arterial graft: a case report and review of the literature. Cardiovasc Intervent Radiol, 2010, 33(1): 182-186.

West China Medical Journal

Fogarty balloon catheter embolectomy for arteriovenous graft thrombosis in hemodialysis patients: an analysis of outcomes

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