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Novel Approach to Percutaneous Thrombolysis in Large Caliber Clotted Vascular Access Using Ultrasound-accelerated Thrombolysis

Purpose End-stage renal disease has a high cost burden to the public. Surgical procedures such as hemodialysis (HD) access creation and transplant have high rates of vascular access complications, infections, and readmissions. Cost of HD care has increased to $19.4 billion in 2011; 30-day readmission rates are as high as 36%. There is a continuing need to preserve the route of vascular access for patients, given frequent thrombosis at a rate of 0.8 episodes per patient year at risk. We describe a novel method of thrombolysis using ultrasound-accelerated thrombolysis (USAT) technology for large caliber clotted vascular access. Methods Consecutive patients with thrombosis of their dialysis vascular access that involved large caliber conduits or those that extended into large and/or central veins (axillary, subclavian, innominate) were chosen to undergo catheter-directed thrombolysis with the EKOS EndoWave system. Results Twelve patients underwent a total of 14 procedures. Complete thrombolysis was achieved after seven procedures at the time of repeat fistulogram. Four patients required percutaneous balloon thombectomy to resolve remaining clot at the arterial anastomosis, and three required rheolytic thrombectomy in the aneurysmal segment of the arteriovenous fistula (AVF). All patients had an associated procedure (percutaneous transluminal angioplasty and/or stent placement) to treat the cause of thrombosis. Conclusions USAT is a safe and effective percutaneous method of thrombolysis in patients who have large clot burden.