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This article presents a review of the treatment of lower-extremity deep venous thrombosis (DVT) with systemic and catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT). Standard treatment including anticoagulation therapy and compression stockings may not be entirely adequate, because a significant proportion of patients eventually develop post-thrombotic syndrome (PTS). Thrombolytic agents might offer a potential advantage because they cause faster and more complete clot resolution, which may reduce or prevent residual vein stenosis and valve damage. Thrombolytic therapy results in greater lysis, but also in higher complication rates than does anticoagulation alone. Major bleeding occurs in 11% of patients treated with thrombolytic therapy. The incidence of PTS tends to be lower in patients treated with thrombolytics. However, several methodological flaws limit the conclusions with respect to reduction in PTS. No adequate randomised controlled trials have been performed comparing CDT or PMT with conventional therapy. Given the current data, thrombolytic treatment, CDT or PMT should not be applied except in extraordinary cases. First, the long-term effectiveness in terms of reducing PTS, although possible, remains uncertain. Second, the risks of thrombolytic therapy and PMT are higher. Third, current conventional therapy is relatively inexpensive, convenient and safe.

Purpose: To evaluate mechanical thrombectomy of occluded hemodialysis access shunts with a recently developed hydrodynamic device., Materials and Methods: Sixty-five thrombosed hemodialysis access shunts were treated in 49 patients. The shunts were of three types: Brescia-Cimino fistulas (24 procedures), polytetrafluoroethylene (PTFE; Gore-Tex) loop grafts (18 procedures), and manufactured homologous vein loop grafts (23 procedures). Clots were removed by means of aspiration caused by the hydrodynamic effect of a high-velocity flow of saline through the catheter (Venturi effect)., Results: Successful declotting was achieved in 58 of 65 (89%) attempts. Early reocclusion occurred in 11 shunts and was successfully treated by means of repeat thrombectomy in five instances. Procedure time averaged 1-1 1/2 hours. The primary patency was similar for the three types of access shunts (P = .09), with a median of 14 weeks (including the initial treatment failures). Assisted patency for polytetrafluoroethylene loop grafts was better than that for the two other types (P = .002). Complications were encountered in 10 of 65 (15%) cases. These included formation of a large local hematoma that resulted in loss of a Brescia-Cimino fistula, two instances of arterial embolization, and one case of pulmonary embolization of thrombus material., Conclusion: Effectiveness of mechanical thrombectomy of occluded hemodialysis access shunts with the described hydrodynamic device is similar to that of alternative treatments such as thrombolysis.

Our purpose was to describe initial experience with a new mechanical thrombectomy catheter for treating haemodialysis fistulae. The Hydrolyser thrombectomy catheter combines thrombus fragmentation by a saline jet with simultaneous low-pressure aspiration. This catheter was used in six cases of dialysis-fistula occlusion. In four instances this was a polytetrafluoroethylene loop, in two cases a Brescia-Cimino fistula. In all cases rapid revascularization was obtained without complications. Reocclusion occurred in one patient, immediate reintervention being successful. Our initial results suggest that the Hydrolyser is a quick, minimally invasive, and useful alternative to the presently accepted methods of revascularizing occluded haemodialysis fistulae.