ABSTRACT
Clotting is a serious problem in patients with A-V shunts. Balloon Embolectomy catheters or irrigating devices are frequently unsuccessful in declotting shunts, resulting in surgical revision of the shunt. Frequent surgical revisions reduce sites of vascular access, making it difficult to perform adequate hemodialysis. New instruments, constructed mainly of stainless steel, have been devised and used to declot A-V shunts. The instruments have been devised for specific purposes and labeled as follows: (1) Explanding Mesh, (2) Helix and (3) Rotating Cutter. These instruments will dislodge and remove organized clots, snare and cut fibrin "flaps", open and enlarge the vessel lumens. They have been used successfully in removing vascular obstructions adjacent to the vessel tips of the shunt or at the site of anastamosis of the shunt and vessel. These are the most common sites of obstruction. By prolonging shunt life we have been able to decrease the number of shunt revisions.
