Novel approach to percutaneous thrombolysis in large caliber clotted vascular access using ultrasound-accelerated thrombolysis

The Journal of Vascular Access
Jessica A ZagoryJon V Schellack

Abstract

End-stage renal disease has a high cost burden to the public. Surgical procedures such as hemodialysis (HD) access creation and transplant have high rates of vascular access complications, infections, and readmissions. Cost of HD care has increased to $19.4 billion in 2011; 30-day readmission rates are as high as 36%. There is a continuing need to preserve the route of vascular access for patients, given frequent thrombosis at a rate of 0.8 episodes per patient year at risk. We describe a novel method of thrombolysis using ultrasound-accelerated thrombolysis (USAT) technology for large caliber clotted vascular access. Consecutive patients with thrombosis of their dialysis vascular access that involved large caliber conduits or those that extended into large and/or central veins (axillary, subclavian, innominate) were chosen to undergo catheter-directed thrombolysis with the EKOS EndoWave system. Twelve patients underwent a total of 14 procedures. Complete thrombolysis was achieved after seven procedures at the time of repeat fistulogram. Four patients required percutaneous balloon thombectomy to resolve remaining clot at the arterial anastomosis, and three required rheolytic thrombectomy in the aneurysmal segment of the arterio...Continue Reading

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Citations

Jul 20, 2017·Cardiovascular Engineering and Technology·Nicholas InstonR Jones
May 10, 2017·Annals of Vascular Surgery·Matthew ThomasMonica Hansrani

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Methods Mentioned

BETA
percutaneous transluminal angioplasty
peripheral arterial bypass

Software Mentioned

EKOS
USAT

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