Updated: Oct 21
Declots are typically added to the case schedule on short notice and can require a substantial amount of time depending on the treatment modality you utilize. Interventional radiologist Dr. Sabeen Dhand walks through his declot technique for dialysis access cases, and how he drastically reduces procedure time using the Argon Cleaner thrombectomy system.
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
Declot procedures for dialysis access are typically added to the board on the day of or the day before the procedure, and can take upwards of two hours to work through depending on the treatment approach.
For routine cases, Dr. Sabeen Dhand gains access towards the heart, mixes Alteplase and contrast into the clot, and uses a thrombectomy device to mix up a visible ‘clot milkshake’ whilst leaving the arterial plug intact. He then gains retrograde access through the arterial anastomosis and pulls the plug to eliminate the majority of the clot burden.
Dr. Sabeen Dhand has found that the Argon Cleaner thrombectomy system can help him complete a declot case in as little as 15 to 20 minutes.
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.
Dialysis Access Declots are Often Requested on Short Notice
Sabeen, do you want to tell us a little bit about how your dialysis practice is shaped up, just briefly? Then we'll go into.
Totally. We have several dialysis access centers around our site. Most of them send patients to us - it was already a very high volume dialysis practice when I started. Most declots specifically are added the day of or the next day and things like that.
Okay. For those of you guys who don't know me, my name's Chris Beck. I'm an Interventional Radiologist in private practice in New Orleans. I'm primarily a hospital-based interventionalist and our dialysis work that we do is - we're actually getting scooped a majority of the time by the dialysis access center. As far as fistula routine maintenance, we do very little of. Most of what I get are declot procedures, usually either tough ones or at inopportune times.
Routine Declot Procedure Using the Argon Cleaner Thrombectomy System
Alright, so let's first go through a routine declot procedure. Sabeen, do you want to start it out?
Yeah. What I do, which is now a little bit different than how I trained, is I get access towards the heart, integrate towards the heart, and I determine the clot burden by just going central and pulling back a five french end-hole catheter. Then through that catheter and through the clot burden, I mix Alteplase into the clot and usually I put some contrast in there too so I can see the actual clot on fluoro. Then, immediately, I use - in each case I use an orbital thrombectomy, mostly the Cleaner. I'll use that to make a clot milkshake, you can say, clot Alteplase milkshake while I still haven't pulled the arterial plug.
That allows the TPA to kind of sit and dwell and then about five minutes of doing the Cleaner, I'll get a retrograde access through the arterial anastomosis and pull the plug. Usually that really takes care of most of the clot. Then I'll address the critical lesions, whether there's a stenosis, unless I saw something really severe initially that would maybe hold up my clot [like something central]...
What's your end point when you're running the Cleaner the first time through?
With the contrast and the TPA, it makes a uniformed kind of haze and then I feel like I really got it mixed up like a milkshake.
Okay. So you can kind of see it spun up.
Yeah. You can see it and that's why I added that contrast thing recently and I liked it more.
Drastically Shorter Declot Procedure Time Using 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.
 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.