Percutaneous rheolytic thrombectomy of thrombosed arteriovenous dialysis access using the AngioJet catheter- A Systematic Review

IntroductionThe endovascular removal of thrombi in occluded arteriovenous (AV) access sites has been increasingly accepted by surgeons as an alternative to surgical thrombectomy and revision [1,2]. This systematic review documents the experiences and outcomes of using the AngioJet Rheolytic Thrombectomy Device for salvaging thrombosed arteriovenous fistulas (AVFs) or grafts (AVGs). MethodsElectronic databases, such as PubMed, Embase, and the Cochrane Library, were searched from their establishment until May 2024. Initially, 549 articles were reviewed for potential inclusion, and only 10 studies fulfilled our inclusion criteria. Our final dataset included 771 patients who underwent 996 thrombectomies to treat 338 thrombosed AVFs and 457 AVGs. ResultsThe demographics, technical and procedural success, patency rates, and complications were evaluated to examine the effectiveness and safety of AngioJet thrombectomy. The mean primary patency rates at 3, 6, and 12 months were 64.09 {+/-} 10.12, 50.36 {+/-} 11.73, and 40.81 {+/-} 15.13 (p < 0.05). The mean assisted primary patency rates at 3, 6, and 12 months were 75.37 {+/-} 13.98, 59.58 {+/-} 14.26 and 40.88 {+/-} 18.81 (p < 0.05). Finally, the mean secondary patency rates at 3, 6, and 12 months were 84.03 {+/-} 8.38, 77.93 {+/-} 9.07, and 65.81 {+/-} 12.12 (p < 0.05). A total of 92 complications were recorded; most were minor complications, thereby being transient and self-limiting. Additionally, 5 total deaths were reported; however, all were not considered related to the AngioJet device. DiscussionOur study deemed devices such as AngioJet efficacious in performing pharmacomechanical thrombectomies, as promising results in terms of safeness and effectiveness to re-establish patency in occluded AVFs and AVGs have been reported.