{"title":"一种新型机械取栓装置XCOILTM在血液透析移植物和瘘管清除手术中的初步临床应用。","authors":"W. Monsky, R. Latchaw","doi":"10.5152/dir.2015.15158","DOIUrl":null,"url":null,"abstract":"PURPOSE\nWe aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOILTM, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae.\n\n\nMETHODS\nIn 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32-69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOILTM (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs. XCOILTM was advanced distal to the thrombus within the outflow vein as well as distal to the arterial inflow platelet thrombin plug, using a 4F angiographic catheter. The percentage of thrombus cleared, primary patency, procedure time, and XCOILTM performance were documented.\n\n\nRESULTS\nThrombosis occurred 1-30 days prior to the procedure. Thrombosed segments of graft/fistula measured 10-50 cm. Pre- and postprocedure angiography demonstrated that in 15 of 18 cases (83%) XCOILTM removed 80%-100% of the venous outflow thrombus. In 11 of 14 cases (79%), the platelet thrombin plug was also removed. Thrombectomy procedure time averaged 8 min, with one to three passes with the XCOILTM required. No evidence of distal embolization or graft/vessel injury was found on angiography following clot removal. In four cases in whom patency was not restored with XCOILTM, subsequent use of other clot removal devices also failed to restore patency. In one case with severe venous stenosis, the device failed to deploy and the thrombus was not captured. No intraprocedural complications related to XCOILTM use occurred.\n\n\nCONCLUSION\nXCOILTM is an effective and safe first-line therapy option for the treatment of thrombosed hemodialysis grafts/fistulae. Rapid removal of intact thrombus and platelet thrombin plug can be achieved without adjunctive thrombolytics.","PeriodicalId":50582,"journal":{"name":"Diagnostic and Interventional Radiology","volume":"22 3 1","pages":"257-62"},"PeriodicalIF":2.1000,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5152/dir.2015.15158","citationCount":"4","resultStr":"{\"title\":\"Initial clinical use of a novel mechanical thrombectomy device, XCOILTM, in hemodialysis graft and fistula declot procedures.\",\"authors\":\"W. Monsky, R. Latchaw\",\"doi\":\"10.5152/dir.2015.15158\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"PURPOSE\\nWe aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOILTM, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae.\\n\\n\\nMETHODS\\nIn 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32-69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOILTM (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs. XCOILTM was advanced distal to the thrombus within the outflow vein as well as distal to the arterial inflow platelet thrombin plug, using a 4F angiographic catheter. The percentage of thrombus cleared, primary patency, procedure time, and XCOILTM performance were documented.\\n\\n\\nRESULTS\\nThrombosis occurred 1-30 days prior to the procedure. Thrombosed segments of graft/fistula measured 10-50 cm. Pre- and postprocedure angiography demonstrated that in 15 of 18 cases (83%) XCOILTM removed 80%-100% of the venous outflow thrombus. In 11 of 14 cases (79%), the platelet thrombin plug was also removed. Thrombectomy procedure time averaged 8 min, with one to three passes with the XCOILTM required. No evidence of distal embolization or graft/vessel injury was found on angiography following clot removal. In four cases in whom patency was not restored with XCOILTM, subsequent use of other clot removal devices also failed to restore patency. In one case with severe venous stenosis, the device failed to deploy and the thrombus was not captured. No intraprocedural complications related to XCOILTM use occurred.\\n\\n\\nCONCLUSION\\nXCOILTM is an effective and safe first-line therapy option for the treatment of thrombosed hemodialysis grafts/fistulae. Rapid removal of intact thrombus and platelet thrombin plug can be achieved without adjunctive thrombolytics.\",\"PeriodicalId\":50582,\"journal\":{\"name\":\"Diagnostic and Interventional Radiology\",\"volume\":\"22 3 1\",\"pages\":\"257-62\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2016-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.5152/dir.2015.15158\",\"citationCount\":\"4\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diagnostic and Interventional Radiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5152/dir.2015.15158\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diagnostic and Interventional Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5152/dir.2015.15158","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 4
摘要
目的:我们旨在评估一种新型导管机械取栓装置XCOILTM作为恢复血栓性透析移植物和瘘管通畅的一线治疗方法的安全性和有效性。方法2010年,18例连续/序贯患者(男性11例,女性7例;平均年龄52岁;年龄范围,32-69岁)闭塞的动静脉移植物(n=15)或瘘管(n=3)使用XCOILTM (NexGen Medical Systems Inc.)治疗,无辅助溶栓药物。采用4F血管造影导管将XCOILTM推进到流出静脉内血栓的远端以及动脉流入血小板凝血酶栓的远端。记录血栓清除率、初级通畅度、手术时间和XCOILTM性能。结果术前1 ~ 30天血栓形成。移植物/瘘管的血栓段测量为10-50厘米。术前和术后血管造影显示,18例患者中有15例(83%)XCOILTM清除了80%-100%的静脉流出血栓。14例中有11例(79%)的血小板凝血酶栓也被移除。取栓手术时间平均为8分钟,需要使用XCOILTM进行1至3次检查。在去除血块后的血管造影中没有发现远端栓塞或移植物/血管损伤的证据。在4例未使用XCOILTM恢复通畅的病例中,随后使用其他凝块清除装置也未能恢复通畅。在一个严重静脉狭窄的病例中,该装置未能部署,血栓未被捕获。无XCOILTM术中并发症发生。结论xcoiltm是治疗血栓性血液透析移植物/瘘管的有效、安全的一线治疗选择。快速去除完整的血栓和凝血酶栓可以实现不辅助溶栓。
Initial clinical use of a novel mechanical thrombectomy device, XCOILTM, in hemodialysis graft and fistula declot procedures.
PURPOSE
We aimed to evaluate the safety and effectiveness of a novel catheter-based mechanical thrombectomy device, XCOILTM, as a first line therapy to restore patency of thrombosed dialysis grafts and fistulae.
METHODS
In 2010, 18 consecutive/sequential patients (11 male, 7 female; median age, 52 years; age range, 32-69 years) with occluded arteriovenous grafts (n=15) or fistulae (n=3) were treated with XCOILTM (NexGen Medical Systems Inc.) without adjunctive thrombolytic drugs. XCOILTM was advanced distal to the thrombus within the outflow vein as well as distal to the arterial inflow platelet thrombin plug, using a 4F angiographic catheter. The percentage of thrombus cleared, primary patency, procedure time, and XCOILTM performance were documented.
RESULTS
Thrombosis occurred 1-30 days prior to the procedure. Thrombosed segments of graft/fistula measured 10-50 cm. Pre- and postprocedure angiography demonstrated that in 15 of 18 cases (83%) XCOILTM removed 80%-100% of the venous outflow thrombus. In 11 of 14 cases (79%), the platelet thrombin plug was also removed. Thrombectomy procedure time averaged 8 min, with one to three passes with the XCOILTM required. No evidence of distal embolization or graft/vessel injury was found on angiography following clot removal. In four cases in whom patency was not restored with XCOILTM, subsequent use of other clot removal devices also failed to restore patency. In one case with severe venous stenosis, the device failed to deploy and the thrombus was not captured. No intraprocedural complications related to XCOILTM use occurred.
CONCLUSION
XCOILTM is an effective and safe first-line therapy option for the treatment of thrombosed hemodialysis grafts/fistulae. Rapid removal of intact thrombus and platelet thrombin plug can be achieved without adjunctive thrombolytics.
期刊介绍:
Diagnostic and Interventional Radiology (Diagn Interv Radiol) is the open access, online-only official publication of Turkish Society of Radiology. It is published bimonthly and the journal’s publication language is English.
The journal is a medium for original articles, reviews, pictorial essays, technical notes related to all fields of diagnostic and interventional radiology.