Efficacy of a Modified Pharmacomechanical Thrombolysis Technique for Endovascular Treatment of Thrombosed Prosthetic Arteriovenous Grafts

Abstract

ObjectiveWe applied a modified pharmacomechanical thrombolysis (PMT) technique to endovascular treatment of thrombosed arteriovenous (AV) grafts without the use of any mechanical thrombectomy devices. The aim of this study was to evaluate the efficacy of the PMT technique in the treatment of thrombosed AV grafts by analyzing the long-term patency.Materials and MethodsEighty-two patients with thrombosed AV grafts were treated with the PMT technique. AV graft surveillance to detect failing/failed access was followed by endovascular treatment.ResultsThe technical and clinical success rates were 95% and 95%, respectively. The total number of thrombolysis sessions was 279. A post-intervention primary patency rate was 45% and 22% at 12 and 24 months, respectively. The secondary patency rate was 96% and 91% at 12 and 24 months, respectively. No major complications were noticed.ConclusionThe modified PMT technique is effective in endovascular treatment of thrombosed AV grafts.

Effect of the time to intervention on the outcome of thrombosed dialysis access grafts managed percutaneously

“…P atent vascular access is critical for patients with kidney failure who rely on regularly scheduled hemodialysis. Detailed evidence-supported guidelines have been developed regarding vascular access placement (1)(2)(3)(4), and much has been written about the surveillance, maintenance, biology, cost, and interventional techniques for these accesses (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Similarly, predictors of success following radiological intervention of these access sites have been evaluated, including pressure, the degree of stenosis, and procedure type (16,17).…”

“…Percutaneous endovascular techniques have proven to be successful with the added benefits of lower cost and periprocedural morbidity when compared to surgical thrombectomy (3,11). Studies have shown that surveillance of indwelling arteriovenous (AV) grafts can reduce the number of thromboses, and that procedure technique can influence success (11,12,(22)(23)(24).…”

Comparison between open and pharmacomechanical repair of acutely thrombosed arteriovenous hemodialysis fistulae within a decade

“…The patency status of the AVF was documented 2 to 40 hours from the thrombus infiltration in an interventional radiology suite by contrast fistulography. One or two 5‐ to 7‐Fr introducer sheath (Terumo, Tokyo, Japan) was inserted into the fistula, and angioplasty of culprit stenosis was performed using a balloon catheters with diameters from 4 to 12 mm (Abbott Vascular, IL, USA or Boston Scientific, MA, USA) . Residual thrombi were managed either by manual thromboaspiration or by mechanical fragmentation techniques.…”

Midterm Results Following Percutaneous Rotational Thrombectomy for Acute Thrombotic Occlusions of Prosthetic Arteriovenous Access Grafts

“…12 Percutaneous endovascular techniques have proven to be successful, with the added benefits of periprocedural morbidity when compared with surgical thrombectomy. 12,13 Studies have shown that surveillance of indwelling AV grafts can reduce the number of thromboses, and that this procedure technique can influence success. 12,14 Today, modern endovascular thrombectomy devices that use different methods of thrombus fragmentation and transportation are commercially available.…”