Percutaneous therapy to maintain dialysis access successfully prolongs functional duration after primary failure

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• The use of endovascular therapy for thrombosed dialysis access is increasing, but data on its effectiveness are limited.
• Dialysis access thrombosis is a common complication that can lead to significant morbidity and loss of access functionality.

Purpose of the Study:

• To evaluate the outcomes of a comprehensive endovascular declot policy for thrombosed dialysis access at a major medical center.
• To characterize success rates, complications, long-term patency, and factors influencing outcomes.

Main Methods:

• A retrospective analysis of patients undergoing endovascular treatment for thrombosed dialysis access between 1997 and 2003.
• Utilized a two-puncture, combined percutaneous mechanical and pharmacologic thrombectomy technique.
• Standardized assessment of fistulograms for lesion characteristics and pre/post-procedure results, with life-table and Cox proportional hazard analyses.

Main Results:

• 114 patients with 174 thrombosed grafts experienced 237 thrombotic events.
• Successful declot was achieved in most cases, with high rates of anastomotic venous stenosis (72%) treated by angioplasty.
• Technical failure rate was 4.6%, with 30-day mortality at 1.7% and major morbidity at 2.4%.

Conclusions:

• A universal endovascular therapy policy for occluded dialysis access successfully reestablishes function in most patients.
• This approach triples functional longevity of dialysis access, despite being procedure-intensive.
• Endovascular therapy demonstrates low morbidity and mortality while preserving future access options.