HDA 1. Novel Use of the ClariVein Catheter for Pharmacomechanical Thrombolysis of Thrombosed Arteriovenous Grafts

The aim of this prospectively collected case series was to demonstrate a novel technique of using the ClariVein (Vascular Insights, Quincy, Mass) catheter for pharmacomechanical thrombolysis of thrombosed hemodialysis grafts. The analysis comprised 37 procedures in 27 patients from July 1, 2016, to December 31, 2017, in which the ClariVein catheter was used in combination with urokinase. Demographic data, procedural data, technical and clinical success rates, and complications were evaluated. The primary and secondary patency rates at 1 month and 3 months were also analyzed. In the 37 procedures performed, the technical and clinical success was 100%. The mean procedural time was 64 minutes (range, 50-90 minutes), and the mean amount of urokinase administered was 87,000 units. The primary unassisted patency rates at 1 month and 3 months were 78.4% and 62.1%, respectively. The secondary patency rates at 1 month and 3 months were 89.2% and 81.1%, respectively. Perforation occurred after balloon angioplasty of the venous anastomosis in 2 (5.4%) of the 37 procedures for which covered stenting was performed. No major complications occurred. The combination use of the ClariVein catheter with urokinase for pharmacomechanical thrombolysis in thrombosed hemodialysis grafts is a feasible and safe method that can be performed in a relatively short time. Our early results have shown 100% technical and clinical success. This case series serves as a platform for an upcoming prospective study to further evaluate this method.