Enhancing Dialysis Access Salvage : Efficacy of Rotational Thrombectomy Over Balloon Maceration with Low Complication Rates

Patients with end-stage renal disease (ESRD) undergoing hemodialysis are at a high riskof developing thrombotic complications in arteriovenous (AV) grafts and fistulas. Thesecomplications can significantly hinder the efficacy of dialysis treatment, leading to increasedmorbidity and healthcare utilization.Traditional salvage techniques, particularly balloonmaceration, have been the mainstay of treatment for thrombosed dialysis access . However,these methods often fall short in terms of efficacy and long-term patency, prompting theexploration of more effective alternatives.The limitations of balloon maceration, including its propensity to compact thrombusagainst the vessel wall rather than removing it, can lead to suboptimal restoration of flowand potentially contribute to the recurrence of thrombosis.This challenge underscores theneed for innovative approaches that can offer both effective declottingand preservation ofthe vascular access site.Rotational thrombectomy, utilizing devices such as the Cleaner XTTM rotational thrombectomy system by Argon Medical Devices Inc. , represents a significant advancement in the management of thrombosed AV access. These devices employ a mechanical action that actively removes thrombus from the vessel wall, a technique that may address the shortcomings of balloon maceration.This study aims to thoroughly evaluate the safety and efficacy of rotational thrombectomy in comparison to balloon maceration, focusing on its success in cases where the latter fails.The efficacy of rotational thrombectomy has been highlighted in multiple studies, including those conducted at the University of Alabamaand the University of Chicago.The University of Alabama’s research demonstrated potential advantages of rotational Thrombectomy in achieving longer primary patency rates compared to balloon maceration.