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Retrospective Comparison of the Amplatz Thrombectomy Device with Modified Pulse-Spray Pharmacomechanical Thrombolysis in the Treatment of Thrombosed Hemodialysis Access Grafts¹

¹ From the Division of Vascular and Interventional Radiology, St Luke's-Roosevelt Hospital Center, 1000 10th Ave, New York, NY 10019. From the 1997 RSNA scientific assembly. Received April 27, 1998; revision requested June 16; final revision received February 12, 1999; accepted March 24. Address reprint requests to S.G.C. (e-mail: scooper@slrhc.org).

PURPOSE: To retrospectively evaluate the Amplatz thrombectomy device (ATD) in the treatment of thrombosed hemodialysis grafts and compare it with modified pulse-spray pharmacomechanical thrombolysis (PPT).

MATERIALS AND METHODS: During a 4-month period, 79 patients presented with 126 episodes of graft occlusion. Percutaneous recanalization was performed by using the ATD (n = 57) or the modified PPT technique (n = 69). Evaluation included the technical success, complications, and primary patency rates.

RESULTS: Technical success was achieved in 93% (53 of 57) of the cases treated with the ATD and in 96% (66 of 69) of the cases treated with modified PPT (P = .70). Complications occurred in 6% (four of 69) of modified PPT procedures and 16% (nine of 57) of ATD procedures. This difference was not statistically significant (P = .08); however, there were significantly more local complications in the ATD group (P = .04). The primary patency rates at 30, 90, and 180 days were 65% and 65%, 36% and 50%, and 26% and 33% for modified PPT and ATD, respectively. Survival curves were found not to differ significantly (P = .49).

CONCLUSION: The ATD and modified PPT were similarly successful in the recanalization of thrombosed hemodialysis access grafts and achieved comparable primary patency rates. The higher rate of local complications and technical difficulties encountered with use of the 8-F ATD limit its usefulness for this indication.

Index terms: Angiography, 91.12 • Dialysis, shunts, 91.442, 91.457 • Grafts, interventional procedures, 91.1264, 91.1265, 91.1282, 91.442 • Grafts, stenosis or thrombosis, 91.751 • Thrombectomy, 91.1282 • Thrombolysis, 91.1264, 91.1265, 91.1282

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