Safety and efficacy of the AngioJet device in the treatment of thrombosed arteriovenous fistula and grafts: A systematic review.

PURPOSE: The AngioJet Hemolytic Thrombectomy Device "AngioJet" (Boston Scientific, Malborough, MA, USA) is a rheolytic thrombectomy device that can be used in the treatment of hemodialysis arteriovenous fistula and graft thrombosis. We aim to appraise the current evidence on AngioJet thrombectomy in hemodialysis vascular access thrombosis, and to determine its safety, including complications and efficacy.

MATERIALS AND METHODS: An electronic literature search was performed on the MEDLINE and Embase databases. References of retrieved articles were also reviewed. Articles using AngioJet for the treatment of arteriovenous fistula or graft were included. Patients less than 18 years old, non-English articles, single case reports, small case series (<5 cases), conference publications, and nonhuman models were excluded.

RESULTS: A total of 688 articles were initially evaluated and 10 articles fulfilled the inclusion criteria, which included 836 patients with 431 grafts and 234 fistulas. Results were heterogeneously reported. The adjusted mean primary patency rates for 1, 3, 6, and 12 months were 64.6%, 43.8%, 42.5%, and 30.5%, respectively; adjusted mean secondary patency rates for 3, 6, and 12 months were 76.5%, 75.1%, and 74.5%, and assisted primary patency rates were 61.9%, 47.3%, and 35.3%, respectively. There were 126 complications, most were minor. There were seven deaths, but were unable to be attributable to the AngioJet.

CONCLUSION: The AngioJet is an effective and safe treatment option for thrombosed fistulas and grafts. However, the quality of the current evidence is poor. Further research with prospective randomized controlled trials using standardized data reporting methods is needed to prove its safety and efficacy.