Recana l i zat ion of a thrombosed A-V shunt in the upper le f t l imb us ing Rotarex ®S catheter

Dr. Jan Porod

Angio a .s. – intervent ional angio logy, pr ivate c l in ic in Př íbram

Introduct ion: Male, 69 years old, with an acute (two days) A-V shunt occlusion. The thrombosis occurred as a result of

dehydration in the summer. The patient was admitted to a primary hospital in Prague, where doctors used

Trerotola. This treatment appeared unsuccessful as it was followed with an early reocclusion after only two days.

There was an urgent need for a patent prosthesis to dialyse the patient. In this case, we decided to perform the

treatment with Rotarex®S. The patient was without any other medication in order to avoid haemostasis issues.

Descr ipt ion of Procedure: The vascular prosthesis, including the anastomosis, was filled with thrombus. Two 6F sheaths were inserted in

a “cross” way directly into the graft. Anticoagulation was achieved with 5.000IU of Heparin. Thrombus in the

prosthesis was successfully aspirated, fragmented and removed by 6 F Rotarex®S (2 passes). Subsequently, the

prosthesis, vein anastomosis and veins behind the anastomosis were dilated with a Sterling OTW PTA balloon

(7 mm). The arterial anastomosis was dilated using a Mini ghost 4 mm PTA balloon. After the intervention, both

anastomoses and prosthesis were fully patent.

For insertion, we highly recommend using two sheaths in opposite directions, since there is no blood flowing in

a completely thrombosed prosthesis to adequately provide cooling for the catheter and transportation of the

removed thrombus. It is necessary to pay attention to regular flushing of the prosthesis with a small amount

of saline.

Medicat ion af ter the Treatment: LMWH 0,5-0,8 ml, other medication was prescribed by the dialysis department.

Fol low Up: Clean prosthesis, flow rates are set by the dialysis department.

Angiogram before Procedure

Angiogram af ter Procedure

After 6 F Rotarex®S cleaning of the venous side

After repeated PTA 7 mm

After PTA 7 mm

After PTA 4 mm

Rat ionale for treatment with the Straub system:The Rotarex® S offers a rapid and safe treatment, allowing clearance of thrombus from the prosthesis on the

arterial as well as venous sides. Use of Rotarex® S with a guidewire allows fast follow-up treatment with PTA if

needed. (Some Trerotola devices are used without a GW.)