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

Abstract

Patent vascular access is critical for patients on regular hemodialysis. Prosthetic grafts are good alternatives when the superficial venous system is of poor quality. However, thrombosis is one of the main drawbacks of synthetic grafts, with reports of 59% to 90% patency rates for 1 year. In cases of thrombotic occlusion of prosthetic arteriovenous fistula grafts, percutaneous mechanical thrombectomy has recently gained clinical popularity as a potential alternative to surgical thrombectomy or pharmacologic thrombolysis. We reviewed our preliminary results from 30 percutaneous rotational thrombectomies performed in a total of 22 patients in the setting of acute dialysis-access prosthetic graft occlusion of the upper extremity. Among the 30 cases of acute occlusion of the arteriovenous graft, immediate success with angiographic flow restoration was observed in all patients except for 2 patients (both females; 6%), with de novo occlusion where reocclusion occurred within 12 hours despite apparent immediate angiographic patency. The mean duration between the initial presentation with acute arteriovenous graft occlusion and the thrombectomy procedure was 27.4 6 12.4 hours. The mean duration of graft patency was 10.45 6 0.6 months. A total of 75% of the arteriovenous grafts were patent at the end of 12 months of follow-up. Female gender, diabetes mellitus, and diagnosis to intervention interval were reviewed for midterm graft failure, and the presence of diabetes mellitus yielded significance (P , 0.05). Percutaneous techniques play important roles in the treatment of failed or failing arteriovenous fistulae and grafts. Ongoing analysis of outcomes of both percutaneous and surgical intervention is necessary to continue to identify optimum treatment algorithms.

Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft

“…Mechanical thrombectomy and catheter-directed thrombolysis were reported to be effective and safe techniques for endovascular graft thrombectomy. 4,[6][7][8][9][10] Catheter aspiration, which accounted for 80% of the endovascular procedures performed in our study, is a simple and effective technique that requires no expensive surgical devices, but it yields comparable results relative to procedure success rate and graft patency.…”

“…Mostly of patients had total graft thrombosis, only 11 of 25 patients in the endovascular group presented with clinical partial graft thrombosis. Median time from graft thrombosis to treatment was 2 days (range: 1-14) in the endovascular group, and 1 day (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14] in the open thrombectomy group (p=0.078). A summary of patient and graft data is shown in Table 1.…”