Arterial venous fistulas and synthetic grafts have become a mainstay in the provision of hemodialysis in patients with chronic renal failure. Unfortunately, greater than 18% of fistulas and grafts thrombose less than 14 months after creation or surgical implantation.¹ Fistula and graft thrombectomy via balloon mediated or mechanical based thrombectomy devices has proven vital for long term care and preservation of aadequate vascular conduit for performance of hemodialysis. Traditional thrombectomy has been performed both open via surgical thrombus extraction and percutaneously utilizing venoplasty balloons or Fogarty style embolectomy catheters. Newer devices designed specifically for use in the treatment of AV fistula and graft thrombosis have been developed to reduce and macerate thrombus burden faster and more efficiently than standard balloon maceration alone. One of these devices, the Cleaner XT™( Argon Medical Devices, Plano, TX) utilizes a mechanical maceration wire that that spins at 4,000 RPM to morcellate thrombus while creating a fluid vortex effect to aid in extraction of thrombus from the native AVF or graft wall to aid in restoration of flow and circuit patency.