Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?

Yeo, Clarice Biru; Yong, Enming; Hong, Qiantai; Kwan, Jun; Quek, Lawrence Han Hwee; Pua, Uei; Punamiya, Sundeep; Chandrasekar, Sadhana; Tan, Glenn Wei Leong; Lo, Zhiwen Joseph

doi:10.3400/avd.oa.20-00112

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…We had previously reported good outcomes with primary patency (PP) of 87% at 12 months and PP of 62% and 36% at 24 and 36 months respectively. 20 The assisted primary patency was 96%, 82% and 69% and the secondary patency was 99%, 93% and 86% at 12, 24 and 36 months respectively. The results are also similar to a previous study which showed that time-extended, locally infiltrated lyse and wait technique had the highest post intervention-assisted primary patency of 82% at 12 months when compared to other declotting techniques.…”

Section: Discussionmentioning

confidence: 87%

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

Lim

Kwan

et al. 2021

J Vasc Access

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Objectives: This paper documents our experience and outcomes of using a relatively new endovascular rotational thrombectomy device for salvage of thrombosed vascular access. Methodology: A retrospective study reviewing patients with thrombosed native AVF or AVG who underwent endovascular declotting using a rotational thrombectomy device between November 2018 and May 2020 at a tertiary university hospital in Southeast Asia. We evaluated demographics, procedural data, technical and procedural success, patency rates and complications. Results: A total of 40 patients underwent single session endovascular declotting of thrombosed vascular access. The mean follow-up period was 21.6 months (range 13.4–31 months). The technical success was 92.5% and clinical success was 80%. About 50% of patients had concomitant thrombolysis for pharmacomechanical thrombectomy. One patient had a myocardial infarction during the post-operative period. There were no other major complications within 30 days. The primary patency was 45.5% at 6 months and 22.7% at 12 months. Assisted primary patency was 68.1% at 6 months and 61.6% at 12 months, which was maintained up to 2 years. The secondary patency was 84.1% at 6 and 12 months. Conclusion: Our study shows that rotational thrombectomy device for single session thrombectomy of thrombosed arteriovenous fistulas and grafts is safe and effective. A high technical and clinical success rate was achieved, with low complication rates and specific advantages compared to other techniques, including reduced length of hospital stay. Our reported mid-term outcomes are reasonable with an assisted primary patency of 62% at 12 and 24 months. The use of newer techniques and novel dedicated thrombectomy devices show promise.

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Section: Discussionmentioning

confidence: 87%

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

Lim

Kwan

et al. 2021

J Vasc Access

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“…Catheter-directed thrombolysis is a minimally invasive therapy method to treat AVF thrombolysis, but significant limitations of lytic therapy exist, including bleeding and intracranial hemorrhage. Previous studies have reported intracranial bleeding rates of approximately 1% [9]. Therefore, to date, the optimal procedure for the treatment of AVF thrombosis remains to be developed.…”

Section: Plos Onementioning

confidence: 99%

Scoop thrombectomy: A declotting technique for the treatment of thrombosed autologous arteriovenous fistula. A single-center retrospective study

Ruan

Yang²,

Ren³

et al. 2022

PLoS ONE

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Background Thrombosis is one of the main complications leading to the failure of autologous arteriovenous fistula (AVF) for patients with renal failure. Thrombectomy is one of the major therapies to remove thrombi to salvage the AVF and prolong its patency. Materials and methods Fifty-six patients with AVF thrombosis at the anastomosis were recruited for this study and underwent thrombectomy procedures. Their clinical variables were collected. The vasculature was accessed at the site of the aneurysmal dilatation. Under ultrasound guidance, a scoop thrombectomy procedure was performed by anterograde and retrograde scooping to remove the thrombus using forceps. Then, a sheath was placed in the direct vertical direction. Angioplasty was performed with a balloon to treat the underlying primary arteriovenous stenosis. Patients were followed up for 12 months after surgery. The procedural success, primary and secondary patency rates, and incidence of procedure-related complications were analyzed. Results There were 2 minor (3.6%) and no major complications. Clinical success was achieved in 55 of the 56 procedures (98.2%). No symptomatic pulmonary embolism or arterial embolization was noted. The primary patency rates at 3, 6, and 12 months were 92.9, 83.8, and 73.3%%, respectively, according to the Kaplan–Meier survival analysis. Conclusion Scoop thrombectomy is a safe procedure with high technical success and a low complication rate, and it is an effective method for patients to receive hemodialysis immediately.

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Modified lyse and wait technique for the treatment of dialysis fistula thrombosis: Percutaneous thrombolytic therapy with a 27‐G dental needle

Ateş

Taydaş

2021

Seminars in Dialysis

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Background The lyse and wait technique is a percutaneous endovascular technique in the treatment of thrombosed dialysis fistulas. In this study, our aim was to introduce a more easily applicable modification of the lyse and wait technique and present our results. Methods A total of 84 patients (56 male; 66.6%), with a mean age of 61 years, were included in the study. The treatment was performed in patients presenting with dialysis fistula thrombosis no more than 1 week before the procedure, whose thrombosed segment length was less than 10 cm. A 27‐G dental needle was inserted into the thrombosed segment under ultrasonography guidance, and 5 mg of alteplase was injected in a controlled manner. After about 6 to 12 h, the patients were taken to the angiography unit, and balloon angioplasty was performed. Results The technical and clinical success of the procedure was 98.8%. Technical and clinical failure occurred in only one patient. The median primary patency duration was 13.5 months. None of the patients had major complications. At the end of 12 months, the primary patency rate was 66.6%, and the secondary patency rate was 80%. Conclusions Our technique has shown to have high technical and clinical success and patency.

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Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?

Cited by 4 publications

References 22 publications

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

Single-centre experience with endovascular rotational thrombectomy for single session salvage of thrombosed arteriovenous fistulas and grafts

Scoop thrombectomy: A declotting technique for the treatment of thrombosed autologous arteriovenous fistula. A single-center retrospective study

Modified lyse and wait technique for the treatment of dialysis fistula thrombosis: Percutaneous thrombolytic therapy with a 27‐G dental needle

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