Fogarty balloon application technique in dislodging residual thrombus on the single sheath entry point at the apex of thrombosed loop grafts

Abstract

PURPOSE We aimed to evaluate the effectiveness of the Fogarty balloon application in dislodging residual thrombus at the sheath entry point in a graft by using single apex puncture to declot thrombosed hemodialysis loop grafts. MATERIALS AND METHODS The apex puncture technique was used in 520 cases to declot 376 hemodialysis loop grafts (male/female, 150/226; mean age, 58 years). The Fogarty balloon application technique, which uses the Fogarty balloon to fill the apex, was used to compress or displace the sheath entry point residual thrombus that did not wash away spontaneously by arterial flow. The frequency of the use of the technique, technical success, complications, and primary patency were evaluated. RESULTS Sheath entry point thrombi were washed away spontaneously in 281 of 520 procedures (54%), and 184 procedures (35.4%) underwent a Fogarty balloon application. For a variety of reasons, the Fogarty balloon application technique was not performed in the remaining 55 procedures (10.6%). The technique was successful in 171 of 184 procedures (92.9%), and failed in 13 procedures, which required additional sheath insertion for the removal of sheath entry point thrombus. Complications included sheath dislodgment from the apex during Fogarty ballooning in one procedure and puncture site bleeding in one procedure. Primary patency was 60%, 35.2%, and 15.3% at 3, 6, and 12 months postprocedure, respectively. CONCLUSION The Fogarty balloon application technique is safe and useful for the removal of residual thrombus at the apical, pen-sheath zone when declotting occluded hemodialysis loop grafts.