Percutaneous Laser-Facilitated Thrombectomy: An Innovative,Easily Applied,and Effective Therapeutic Option for Recanalization of Acute and Subacute Thrombotic Hemodialysis Shunt Occlusions

Abstract

Purpose:

To report our experience with excimer laser—facilitated recanalization of acute and subacute thrombotic occlusions of hemodialysis shunts.

Methods:

Twenty-one patients (16 women; mean age 54±19 years, range 31–76) presented with acute and subacute thrombotic occlusions of their hemodialysis shunts (4 Cimino, 17 prosthetic; 18 forearm, 3 upper arm); mean occlusion time was 4.1±3 days (range 1–14), and the thrombotic occlusion measured a mean 17.4±9 cm (range 5–27). Fresh thrombus was observed in addition to the total shunt occlusion in all cases. All patients were treated initially with a pulsed ultraviolet (308-nm) excimer laser. Eighteen (85.7%) patients received adjunctive local thrombolysis for treatment of residual thrombus. Nineteen (90.5%) patients underwent angioplasty of the underlying anastomotic stenosis.

Results:

The angiographic occlusion was reduced from 100% to 63%±28% after laser treatment and to 36%±18% after 1 hour of thrombolytic therapy (20 mg tissue plasminogen activator). TIMI flow increased significantly from grade 0 to 2.7±0.5 following laser ablation (p<0.001) and to 3.0±0.2 upon completion of the angioplasty procedure (p>0.001 versus baseline). The immediate procedural success was 95.2% (20/21). Detectable thrombotic embolization and laser-related complications were not observed in any case. Primary patency was 85%; 3 patients had abnormal Doppler flow within 6 weeks and underwent reintervention (secondary patency 100%). All successfully treated shunts were usable for further dialysis at the 6-week follow-up.

Conclusion:

Percutaneous excimer laser-facilitated thrombus vaporization is safe and effective for recanalization of acute and subacute thrombotic occlusions of hemodialysis shunts.