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Abstract: TH-PO281

Saving Vascular Access and Reducing Risks of Complications in Catheter Related Thrombosis: Our Experience With the FlowTriever® Device

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access


  • Maza Rodas, Gabino Manuel M, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Gardezi, Ali I., University of Wisconsin-Madison, Madison, Wisconsin, United States

Among patients undergoing hemodialysis, around 18% of prevalent HD patients with ESRD use central venous catheter as vascular access.
Catheter related thrombosis is a relatively common complication in patients with long term central venous catheter resulting in catheter malfunction, loss of vascular access and risk of venous thromboembolism.

Case Description

71 years old female with a past medical history of heparin induced thrombocytopenia, diabetes type 2, hypertension, end stage renal disease on intermittent hemodialysis who presented with shortness of breath. On exam, patient was hypertensive and hypoxic on room air. She had a right femoral vein tunneled hemodialysis catheter. Patient had magnetic resonance angiogram (MRA), which was negative for pulmonary embolism but showed a thrombus within the inferior vena cava associated with the tip of the dialysis catheter. MRA of abdomen, pelvis and right lower extremity to evaluate extent of thrombosis. Thrombus was nonocclusive and extended from the level of the renal veins to the liver.

Anticoagulation with Apixaban was started. Interventional cardiology performed aspiration thrombectomy of the right atrium, inferior vena cava and catheter related thombi using FlowTriever® system, and which enabled us to preserve access and minimize risks of thromboembolism.


Anticoagulation is the mainstay of treatment for catheter related thrombosis, provided there are no contraindications. For catheter-tip atrial thrombus, the catheter should remain in place to reduce the risk of embolization until the thrombus has resolved.

If symptomatic thrombus is present, catheter should be removed. However, if vascular access is limited, it is possible to preserve the catheter. Other therapies include catheter directed therapy with local administration of a thrombolytic agent or physical aspiration of the thrombus, or both. In some instances, with thrombus extension > 6 cm, systemic thrombolysis may be considered as a second-line therapy.

At our institution, we have available the FlowTriever® system, in which a large bore sheath is introduced for placement of suction catheter, which is connected to a retraction aspirator, providing vacuum for clot aspiration. The advantage is that it can remove large volumes of thrombus rapidly.