Interventions for thrombosed haemodialysis arteriovenous fistulas and grafts

Fonseca, Andre V; Barros, Marcos G Toledo; Baptista-Silva, Jose CC; Amorim, Jorge Eduardo de; Vasconcelos, Vladimir

doi:10.1002/14651858.cd013293

Cited by 2 publications

(2 citation statements)

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“…We look forward to the results of the Cochrane systematic review by Fonseca and colleagues (2019), which will provide important insight into the comparative effectiveness of surgical and endovascular interventions for AVG thrombosis in the modern era. 27 Our study has several limitations. First, this is a retrospective analysis of our experience in a large academic health network.…”

Section: Discussionmentioning

confidence: 91%

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Long-term outcomes following thrombolysis of arteriovenous grafts

Abdelmasih

Eisenberg

et al. 2021

J Vasc Access

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Background: Thrombolysis for arteriovenous grafts (AVG) yields high technical success rates, however, long-term outcomes are unclear. We conducted a multicenter retrospective cohort study to analyze 5-year patency rates following AVG thrombolysis. Methods: All patients who underwent AVG thrombolysis between 2005 and 2015 at three academic hospitals were included. Prospectively maintained institutional nephrology and radiology databases were used to record demographic, clinical, and AVG characteristics. The primary outcome was primary patency, defined as AVG access survival without re-intervention including angioplasty ± stent with/without re-thrombolysis. Secondary outcomes were assisted primary patency and cumulative patency, defined as AVG access survival until re-thrombosis requiring re-thrombolysis or abandonment, respectively. Technical success was defined as restoration of flow with <30% residual stenosis. Patients were followed until 2017. Patency rates were assessed using Kaplan–Meier survival analysis and Cox proportional hazards were calculated to determine associations between covariates and patency loss. Results: Seventy-four patients underwent AVG thrombolysis during the study period with a median follow-up period of 21.4 (IQR 8.3–42.8) months. The average age was 58.6 years with a high rate of comorbidities, including hypertension (82.4%) and diabetes (54.1%). Thrombolysis technical success was 96%. There were 147 re-interventions in 46 patients, of which 98 were re-thrombolysis (mean re-intervention rate of 1.27/patient/year). Primary patency at 1, 3, and 5 years were 43.2%, 20.2%, and 7.7%. Assisted primary patency at 1, 3, and 5 years were 47.5%, 20.2%, and 7.7%. Cumulative patency at 1, 3, and 5 years were 75.0%, 38.8%, and 22.6%. Cox proportional hazards analysis demonstrated no associations between demographic, clinical, and procedural characteristics and patency rates. Conclusions: Despite a high technical success rate, thrombolysis for AVG dysfunction is associated with poor long-term patency. Future studies are needed to determine risk factors for re-thrombosis to identify patients who will benefit from AVG thrombolysis in the long-term.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%