Journal article
Dialysis grafts arterial plug: Retrieval using the tulip sheath device in vitro
Cardiovascular and interventional radiology, Vol.20(2), pp.154-158
03/1997
DOI: 10.1007/s002709900126
PMID: 9030510
Abstract
The “arterial plug” is a resistant thrombus that frequently persists at the arterial anastomosis of clotted hemodialysis grafts following thrombolytic therapy. We studied the physical and morphological characteristics of the plug and determined the feasibility of transcatheter removal in vitro using the tulip compression thrombectomy system. Sixteen thrombus plugs were recovered during surgical thrombectomy of clotted human dialysis grafts. The physical and gross physical characteristics of all plugs were analyzed. Eight specimens were evaluated microscopically. Transcatheter compression thrombectomy of eight plugs was attempted in vitro. Each plug was embedded in a polyvinyl tube filled with newly clotted blood and connected to a flow circuit. First, balloon-assisted aspiration thrombectomy (BAT) of soft thrombus was performed, while sparing the distal-most segment containing the plug. The tulip sheath was then introduced facing the “arterial end” of the tube. The thrombus segment containing the plug was pulled back into the tulip mesh using either a 3 Fr Fogarty balloon catheter or a self-expanding rake. The tulip was closed to compress and remove the trapped plug. Near-complete thrombectomy of soft clot was achieved in all tested tubes. Compression and retrieval of the entire arterial plug was successful in all except one, where only partial compression of the plug occurred, presumably due to fibrotic changes. No fragmentation or embolization occurred in the remaining procedures. Spongy consistency was noted in 94% of the specimens. Microscopic evaluation showed organized layered thrombus with compaction in five plugs. Transcatheter removal of a thrombus plug is feasible in vitro using the tulip compression-thrombectomy system.
Details
- Title: Subtitle
- Dialysis grafts arterial plug: Retrieval using the tulip sheath device in vitro
- Creators
- Melhem Sharafuddin - Department of Radiology University of Minnesota, Hospital and Clinic 420 Delaware St., S.E. 55455 Minneapolis MN USAJack Titus - The Jesse E. Edwards Registry of Cardiovascular Disease 255 North Smith Avenue 55102 St. Paul MN USAXiaoping Gu - Department of Radiology University of Minnesota, Hospital and Clinic 420 Delaware St., S.E. 55455 Minneapolis MN USADavid Hunter - Department of Radiology University of Minnesota, Hospital and Clinic 420 Delaware St., S.E. 55455 Minneapolis MN USAKurt Amplatz - Department of Radiology University of Minnesota, Hospital and Clinic 420 Delaware St., S.E. 55455 Minneapolis MN USA
- Resource Type
- Journal article
- Publication Details
- Cardiovascular and interventional radiology, Vol.20(2), pp.154-158
- Publisher
- Springer-Verlag; New York
- DOI
- 10.1007/s002709900126
- PMID
- 9030510
- ISSN
- 0174-1551
- eISSN
- 1432-086X
- Language
- English
- Date published
- 03/1997
- Academic Unit
- Radiology; Surgery
- Record Identifier
- 9984051734102771
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