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Why do grafts clot despite access blood flow surveillance?
Massoud Arbabzadeh1, Bhupendra Mepani, Brian M Murray
1Department of Medicine, Erie Co. Medical Center, Buffalo, New York 14216, USA.
Cardiovascular and Interventional Radiology
|November 5, 2002
Summary
Graft thrombosis can occur even with access blood flow (ABF) surveillance. Radiological thrombectomy offers over 70% success, with 35% long-term survival for clotted polytetrafluoroethylene grafts.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Dialysis Access Management
Background:
- Polytetrafluoroethylene (PTFE) grafts are crucial for hemodialysis access.
- Graft thrombosis remains a significant complication, impacting patient outcomes.
- Access blood flow (ABF) surveillance aims to detect and prevent thrombosis.
Purpose of the Study:
- To investigate graft thrombosis despite ABF surveillance.
- To evaluate the efficacy of radiological thrombectomy for clotted PTFE grafts.
Main Methods:
- Retrospective review of PTFE grafts that clotted between September 1998 and October 2000.
- Monthly ABF monitoring with prophylactic angioplasty for flow below 600 ml/min or a 25% decrease.
- Analysis of radiological thrombectomy outcomes.
Main Results:
- 31 of 62 monitored grafts clotted.
- Radiological thrombectomy was performed in 19 grafts.
- Successful thrombolysis in 14 grafts, with improved ABF (p <0.05).
- 6-month graft survival was 37% after radiological intervention.
Conclusions:
- A significant percentage of graft thromboses occur despite ABF surveillance, sometimes with preserved flow.
- Radiological thrombectomy and angioplasty can achieve over 70% success.
- Long-term graft survival after intervention is approximately 35% at 6 months.