Safety and efficacy of thrombectomy using vascular snare for the chronic organized thrombi in patients with thrombosed native hemodialysis fistula

Purpose
To evaluate the safety and efficacy of the thrombectomy using a vascular snare for the chronic organized thrombi in patients with thrombosed native hemodialysis fistula (AVF).
Materials and Methods
The electronic medical records of the patients who underwent recanalization for thrombosed AVF from January 2019 to June 2022. During the study period, a total of 20 native fistulas (14 brachiocephalic, 5 radiocephalic, and one radiobasilic) were treated using a vascular snare in 19 patients. Characteristics of the AVF, endovascular procedures, technical and clinical results, and complications were evaluated.
Results
Total thrombosis was observed in 13 fistulas. Aneurysmal changes were found in 15 fistulas. Thrombectomy using a vascular snare was initiated in 5 fistulas or followed insufficient thrombectomy with a rotational percutaneous thrombectomy device (PTD) in 15. Additional aspiration and adjunctive balloon angioplasty were performed in all procedures. Thrombolysis was performed in 6 hours before thrombectomy procedure in one fistula. Mean procedure time except thrombolysis was 79 minutes (SD 31.5). Technical and clinical success rates were 90% (18/20) and 95% (19/20), respectively. Massive pulmonary embolism requiring emergent cardiopulmonary resuscitation was occurred in one patient, resulted in the failure of hemodialysis with AVF.
Conclusion
The use of a vascular snare was safe and highly effective for the removal of chronic organized thrombi in the recanalization procedures of thrombosed AVF.