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Title: 'Pull and Park': An Alternative Means of Achieving Hemostasis in Percutaneous Aspiration Thrombectomy of an Arteriovenous Fistula for Dialysis

Abstract

No abstract prepared.

Authors:
;  [1];  [2]; ;  [1]
  1. Leicester Royal Infirmary, Department of Vascular and Endovascular Surgery (United Kingdom)
  2. Leicester Royal Infirmary, Department of Radiology (United Kingdom)
Publication Date:
OSTI Identifier:
21091298
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 29; Journal Issue: 1; Other Information: DOI: 10.1007/s00270-004-0237-8; Copyright (c) 2006 Springer Science+Business Media, Inc.; www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD CIRCULATION; DIALYSIS; KIDNEYS; MEMBRANES; VASCULAR DISEASES

Citation Formats

Karkos, Christos D., E-mail: ckarkos@hotmail.com, Dyer, Tristan G., Blanshard, Keith S., Dennis, Martin J., and McCarthy, Mark J.. 'Pull and Park': An Alternative Means of Achieving Hemostasis in Percutaneous Aspiration Thrombectomy of an Arteriovenous Fistula for Dialysis. United States: N. p., 2006. Web. doi:10.1007/S00270-004-0237-8.
Karkos, Christos D., E-mail: ckarkos@hotmail.com, Dyer, Tristan G., Blanshard, Keith S., Dennis, Martin J., & McCarthy, Mark J.. 'Pull and Park': An Alternative Means of Achieving Hemostasis in Percutaneous Aspiration Thrombectomy of an Arteriovenous Fistula for Dialysis. United States. doi:10.1007/S00270-004-0237-8.
Karkos, Christos D., E-mail: ckarkos@hotmail.com, Dyer, Tristan G., Blanshard, Keith S., Dennis, Martin J., and McCarthy, Mark J.. Wed . "'Pull and Park': An Alternative Means of Achieving Hemostasis in Percutaneous Aspiration Thrombectomy of an Arteriovenous Fistula for Dialysis". United States. doi:10.1007/S00270-004-0237-8.
@article{osti_21091298,
title = {'Pull and Park': An Alternative Means of Achieving Hemostasis in Percutaneous Aspiration Thrombectomy of an Arteriovenous Fistula for Dialysis},
author = {Karkos, Christos D., E-mail: ckarkos@hotmail.com and Dyer, Tristan G. and Blanshard, Keith S. and Dennis, Martin J. and McCarthy, Mark J.},
abstractNote = {No abstract prepared.},
doi = {10.1007/S00270-004-0237-8},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 29,
place = {United States},
year = {Wed Feb 15 00:00:00 EST 2006},
month = {Wed Feb 15 00:00:00 EST 2006}
}
  • PurposeThis study was designed to evaluate the technical success and the early clinical outcome of patients undergoing percutaneous aspiration thrombectomy (PAT) for the treatment of arterial thromboembolism following percutaneous infrainguinal transluminal angioplasty (PTA).MethodsIn this single-center study, during a period of 7 years retrospectively, 47 patients (22 male, 47 %) with a mean age of 73 (range 53–96) years were identified in whom PAT was performed for the treatment of thromboembolic complications of infrainguinal PTA. Primary technical success was defined as residual stenosis of <50 % in diameter after sole PAT, whereas secondary technical success was defined as residual stenosis of <50 % in diametermore » after PAT and additional PTA and/or stenting. Clinical outcome parameters (e.g., need for further intervention, minor/major amputation) were evaluated for the 30-day postinterventional period.ResultsPrimary technical success was achieved in 64 % of patients (30/47); secondary technical success was obtained in 96 % of patients (45/47). Clinical outcome data were available in 38 patients. In 87 % of patients (33/38), there was no need for further intervention within the 30-day postinterventional period. In three patients, minor amputations were conducted due to preexisting ulcerations (Rutherford Category 5 respectively).ConclusionsPAT enables endovascular treatment of iatrogenic thromboembolic complications after PTA with good technical and early clinical results and minimal morbidity.« less
  • PurposeThe purpose of this study was to compare the efficacy of percutaneous aspiration thrombectomy (PAT) followed by standard anticoagulant therapy, with anticoagulation therapy alone, for the treatment of acute proximal lower extremity deep vein thrombosis.MethodsIn this randomised, prospective study, 42 patients with acute proximal iliofemoral deep vein thrombosis documented via Doppler ultrasound examination, were separated into an interventional treatment group (16 males, 5 females, average age 51 years) and a medical treatment group (13 males, 8 females, average age 59 years). In the interventional group, PAT with large-lumen 9-F diameter catheterisation was applied, after initiation of standard anticoagulant therapy. Balloon angioplasty (nmore » 19) and stent implementation (n: 14) were used to treat patients with residual stenosis (>50 %) after PAT. Prophylactic IVC filters were placed in two patients. The thrombus clearance status of the venous system was evaluated by venography. In both the medical and interventional groups, venous patency rates and clinical symptom scores were evaluated at months 1, 3, and 12 after treatment.ResultsDeep venous systems became totally cleared of thrombi in 12 patients treated with PAT. The venous patency rates in month 12 were 57.1 and 4.76 % in the interventional and medical treatment groups, respectively. A statistically significant improvement was observed in clinical symptom scores of the interventional group (PAT) with or without stenting (4.23 ± 0.51 before treatment; 0.81 ± 0.92 at month 12) compared with the medical treatment group (4.00 ± 0.63 before treatment; 2.43 ± 0.67 at month 12). During follow-up, four patients in the medical treatment and one in the interventional group developed pulmonary embolisms.ConclusionsFor treatment of acute deep vein thrombosis, PAT with or without stenting is superior to anticoagulant therapy alone in terms of both ensuring venous patency and improving clinical symptoms. PAT is a safe, inexpensive, and easily performed method of endovascular treatment with a low rate of major complications. Our present findings and literature data suggest that PAT can be used as first-line treatment in proximal deep vein thrombosis patients, especially when thrombolytic treatment is contraindicated.« less
  • Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.
  • A stent-graft was custom made to close a high-flow traumatic arteriovenous fistula of the left superficial femoral artery, present for 30 years, in a 60-year-old man with congestive heart failure and ischemic ulceration in the left foot. A balloon expandable Palmaz stent (P394; 2.5 mm x 3.9 cm) was covered with a polytetrafluoroethylene (PTFE) graft and was inserted percutaneously through an 11 Fr vascular sheath. Follow-up Doppler ultrasound at 6 months demonstrated occlusion of the arteriovenous fistula, patency of the artery, and luminal integrity of the artery and vein.
  • Purpose: To evaluate failing hemodialysis arteriovenous fistulas with helical CT angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA), and to compare the efficacy of the three techniques in detecting the number, location, grade, and extent of stenoses and in assessing the technical results of percutaneous transluminal angioplasty (PTA) and stenting.Methods: Thirteen patients with Brescia-Cimino arteriovenous fistula malfunction underwent MRA and CTA of the fistula and, within 1 week, DSA. A total of 11 PTAs were performed; in three cases an MR-compatible stent was placed. DSA served as the gold standard for comparison in all patients. The presence, site,more » and number of stenoses or occlusions and the technical results of percutaneous procedures were assessed with DSA, CTA, and MRA.Results: MRA underestimated a single stenosis in one patient; CTA and MRA did not overestimate any stenosis. Significant artifacts related to stent geometry and/or underlying metal were seen in MRA sequences in two cases.Conclusions: CT and MRI can provide information regarding the degree of vascular impairment, helping to stratify patients into those who can have PTA (single or multiple stenoses) versus those who require an operative procedure (occlusion). Conventional angiography can be reserved for candidates for percutaneous intervention.« less