Updated: Mar 8, 2019
If you’re looking at upgrading your declot procedure kit and simplifying your dialysis access cases, you may want to consider the Argon Cleaner thrombectomy system. Interventional radiologists Dr. Sabeen Dhand and Dr. Chris Beck discuss the pros and cons of the Cleaner to help you evaluate, and provide tips to help you maximize declot success.
We’ve provided the highlight reel and some insightful quotes from our IR guests in this article, but you can listen to the full podcast on the BackTable App, or check out the full transcript here. And if you’d like to follow up on this topic in more depth, we’ve provided some additional resources at the end of this article.
The BackTable Brief
When comparing the Cleaner to other Thrombectomy systems, Dr. Dhand and Dr. Beck agree that the directionality, sturdiness, and tactile feedback of the Cleaner make it especially easy to use.
The Cleaner can streamline declot workflow and drastically reduce procedure time. Learn more about using the Cleaner in our previous article.
The Cleaner is not an over the wire system; operators have to forfeit their wire access when working with the Cleaner.
The Cleaner can be more expensive than traditional techniques like balloon maceration or clot lysis, which may not always justify its time savings.
Disclaimer: The opinions expressed by the participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Weight, Directionality, and Tactile Feedback Make the Argon Cleaner Easy to Use
One of the things that I do like about the Cleaner that maybe some other thrombectomy systems are lacking is that it's got some body to it and it's also got some directionality. Just by kind of changing how much of the Cleaner is exposed, you can kind of get some directionality to the Cleaner.
For me, that's one of the things I really liked about it is that I found it easier to navigate. Sometimes if you find yourself in a stick-site fistula and if you're not dealing with an over the wire system but you have the Cleaner, you can kind of direct it towards the outflow of the fistula, which I find helpful...
You got any tips or tricks as far as how to maximize or optimize the use of the Cleaner? Like do you use the side port at all, massage the fistula at all?
Yeah, that second point I was gonna say, I use [massage] fistula. You can feel the Cleaner actually working under your hand and you know that you're getting that wall apposition. As far as tips, again, unsheathing trick if you're worried about not being able to advance it through a fistula circuit. I think it's generally very easy to use, straight forward and, again, atraumatic so you're not going to have any problems.
Someone had suggested to me using a Cleaner through an aspiration catheter, and eight french aspiration catheter, that could maybe increase it's utility, but I haven't tried that.
Reduced Declot Procedure Time with the Argon Cleaner
I'm interested to hear, Sabeen, why do you start out just going Cleaner? Is it because you found with traditional methods it's harder to get open or this is kind of a faster system for you?
I do find it significantly faster. I referred to being trained a different way where we wouldn't use orbital thrombectomy, we would actually pulse spray the TPA and balloon macerate. I always found declots to be very cumbersome, about a two hour case, two and a half hour case. When I went to my practice now and was taught this way, I noticed the declots go significantly faster.
Whether it's due to this or just experience, I just got to the Cleaner all the time. I get a great result.
...I think it's very easy to use and I do think it has significantly decreased my declot times, especially in a dialysis graft, now some of those declots take 15 to 20 minutes, whereas, I remember, in fellowship, the last thing you wanted to do was a declot at three P.M.
For my standpoint, I'm a fan of the Cleaner, I like the Cleaner. For most of the declots I do I try and do it on the cheap and try just use basic stuff, but I certainly use it as a troubleshooting mechanism. I find it particularly helpful for big stick site aneurysms where I gotta go and clean out a large clot burden. Not that you can't do that with some traditional techniques like balloon maceration or just lysing the clot, but I found that the Cleaner decreases my procedure time. As far as success rates, I think I'm getting the same technical success, it just takes me a shorter period of time, which is helpful.
The Argon Cleaner is Not an Over the Wire System
The only thing I can think of that's negative, what I have to deal with in the Cleaner, is that it's not over the wire. In some instances when you have a really tough venous anastomosis, you do have to bail on your wire access and when I'm doing that I can get a little bit worried.
I do like that it comes in six and seven french, I feel the seven french system I'll use too. Usually I use the six french, but I'll use the seven french system if I have a pseudo aneurysmal fistula. I feel like it gets me better wall apposition. It works well, the only [negative] thing would be the wire, the loss of wire access.
Now, I get Sabeen's point in that I think most of us, it's just inherent that you want something over the wire; it feels very stable, it feels very safe...Most of the time [when] I'm using it, I've already gotten wire access so I've got to pull it and then start running the Cleaner though.
Yeah. No, I'm doing that too. Then sometimes if I have to - a little twist I'll use a longer sheath and I'll pin-pull the Cleaner out and I'll pull it back while I'm making the milkshake.
 Hemodialysis access thrombosis review: http://cdt.amegroups.com/article/view/16884/17196
 Argon Cleaner product page: https://www.argonmedical.com/products/cleaner-rotational-thrombectomy-system
 Argon Cleaner product video: https://www.youtube.com/watch?v=r8MVI0_m-m8
Dr. Sabeen Dhad is a practicing interventional radiologist with PIH Health in Los Angeles.
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
Cite this podcast:
BackTable, LLC (Producer). (2018, March 21). Ep 25 – Declots and the Argon Cleaner Device [Audio podcast]. Retrieved from https://www.backtable.com/podcasts
The Materials available on the BackTable Blog are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients.
The podcast referenced in this article was sponsored by Argon Medical Devices.