1. Scoop thrombectomy is a safe and effective novel technique for treating thrombosed arteriovenous fistulas (AVFs) used for hemodialysis.
Evidence Rating Level: 2 (Good)
For the millions of individuals worldwide with end-stage renal disease (ESRD), the creation of an arteriovenous fistula (AVF) is vital to receive hemodialysis. However, AVFs are prone to failure, particularly due to thrombi. Current treatments for AVF thrombi include surgical and endovascular intervention, which can have less-than-ideal patency rates, and can also have complications in 8-10% of patients, such as losing areas that would have been potential candidates for subsequent AVF creation. Therefore, this study proposed a novel scoop thrombectomy technique, and evaluated its patency and complication rates with a retrospective cohort. This scoop thrombectomy involves removing thrombi from an AVF with hemostatic forceps, then employing high-pressure balloon angioplasty, all under ultrasound guidance. The study consisted of 56 scoop thrombectomy procedures, with a mean time of 68 minutes. The results showed success in 98.2% of scoop thrombectomies, with the ability to use the AVF for hemodialysis right after. 1 patient (1.8%) had a failed procedure, which was attributed to significant calcification of the area. Additionally, the patency rates at 3, 6, and 12 months were 92.9, 83.8, and 73.3% respectively, with a mean time of 11.2 months (95% CI 10.4-12.1 months) before a subsequent procedure is done with regards to access for hemodialysis. Lastly, 2 patients (3.6%) had a complication, both of which were puncture site hematomas. In conclusion, this study demonstrated the efficacy and safety of the scoop thrombectomy procedure for thrombosed AVFs.
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