BackTable / VI / Podcast / Episode #25
Declots with the Argon Cleaner Device
with Dr. Sabeen Dhand
From the Exhibitor's Hall at SIR 2018 in Los Angeles, Dr. Christopher Beck and Dr. Sabeen Dhand describe their declot techniques, with an emphasis on when and how they use the Argon Cleaner device for these cases.
BackTable, LLC (Producer). (2018, March 21). Ep. 25 – Declots with the Argon Cleaner Device [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Sabeen Dhand
Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, Dr. Sabeen Dhand joins Dr. Christopher Beck to discuss arteriovenous access declot procedure with the Argon Cleaner device. We review the routine declot procedure and the different methods to get access. Dr. Dhand explains why he starts out using the Argon Cleaner device and what his endpoint is. We discuss the nuances of the device in addition to tips and tricks for using the device with declots, including external massaging the fistula and an unsheathing trick.
Alright, so let's first go through a routine declot procedure. Sabeen, 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.
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