Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study

PURPOSE: To evaluate the feasibility, efficacy, and safety of mechanical thrombectomy of occluded dialysis access with use of a rotating mini-pigtail catheter. MATERIALS AND METHODS: Thrombus was fragmented by mechanical action of the rotating pigtail tip (5-mm diameter), while the guide wire exited a sidehole at the pigtail curvature and served as a fixed rotation axis. Twenty-six procedures were performed in 22 patients (12 men, 10 women; mean age, 55.5 years). Native fistulas were treated in 15 instances, polytetrafluoroethylene (PTFE) grafts were treated in 11 instances. Average occlusion time was 20 hours +/- 13 (range, 5-46 hours), average occlusion length was 25.6 cm +/- 10.1 (range, 6-45 cm). Thrombus fragmentation was followed by balloon angioplasty of underlying stenoses. RESULTS: In all 26 procedures, the dialysis access was successfully declotted with subsequent dialysis using the access (clinical success rate, 100%). Handling of the mini-pigtail catheter was simple and rapid, regardless of whether a graft or a native fistula was treated. Average duration of the intervention was 118 minutes +/- 30. Mean primary patency was 165 days +/- 167. Primary patency rate was 82% at 30 days, 65% at 3 months, and 47% at 6 months. There was no evidence of complications due to the thrombus fragmentation procedure. CONCLUSION: The results suggest that declotting of occluded dialysis grafts and fistulas with the mini-pigtail catheter is as effective and safe as other more established percutaneous therapies. It may serve as an easy-to-handle, low-budget alternative to current thrombectomy devices.