Does surgical intervention significantly prolong the patency of failed angioaccess grafts previously treated with...

In the last decade, percutaneous techniques have been increasingly used to treat angioaccess graft thrombosis. Often when catheter-based treatment fails, surgeons are called upon to treat these occluded bridge fistulas. It has been our impression that operative intervention has not significantly increased the longevity of angioaccess grafts that have failed percutaneous intervention. During a 2-year period, 101 operative procedures were performed on failed bridge fistulas. All had previously been treated with percutaneous thrombolysis and dilatation. The number of previous interventions ranged from one to five. Primary patency rates of the angioaccess grafts following surgical revision were 43%, 24%, and 12% at 30, 60, and 90 days, respectively. We conclude that surgical intervention does not significantly prolong the patency of angioaccess grafts that have previously failed percutaneous interventions and that its routine use cannot be recommended.