BACKGROUND: Hemodialysis access thrombosis is the primary cause of access failure. Thrombus removal is an effective strategy to restore access function. Although both open surgical and endovascular procedures enable thrombus clearance, endovascular thrombus reduction therapy is widely adopted in clinical practice for this condition due to its minimally invasive and effective properties. METHODS: We describe a novel separator-assisted catheter thrombectomy technique for the management of hemodialysis access thrombosis. In this procedure, a large-bore catheter is used for negative-pressure thrombus aspiration, with an embolus separator concurrently utilized to disrupt intraluminal thrombus and maintain catheter patency during aspiration. RESULTS: This approach effectively enhances thrombus clearance efficiency and shortens procedural time. In our reported thrombectomy cases involving arteriovenous fistula (AV fistula), arteriovenous graft (AV graft), and central venous catheters, the SWAM (Separator With Aspirator for Mechanical Thrombectomy) technique achieved favorable therapeutic efficacy for acute thrombus and, to a certain extent, for chronic thrombus. CONCLUSION: This technique provides a novel therapeutic alternative for the management of hemodialysis access thrombosis.
Li et al. (Sun,) studied this question.