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Fistulogram after arteriovenous dialysis graft thrombectomy should be mandatory

Shakthi D Kumar1, Krishna M Jain, Shikha Jain

  • 1Kalamazoo Center for Medical Studies, Michigan State University, College of Human Medicine, Kalamazoo, Michigan, USA. kumarsh2@msu.edu

The American Surgeon
|December 23, 2008
PubMed

Insights

Routine fistulogram after arteriovenous dialysis graft thrombectomy significantly increases lesion identification and improves graft patency. This procedure is recommended to enhance dialysis access longevity and function.

Area of Science:

  • Vascular Surgery
  • Nephrology
  • Interventional Radiology

Background:

  • Thrombectomy is a common procedure for prosthetic arteriovenous dialysis grafts.
  • Graft patency after thrombectomy can be limited by underlying lesions.
  • Identifying and correcting these lesions is crucial for long-term graft function.

Purpose of the Study:

  • To evaluate if routine fistulogram after thrombectomy identifies correctable lesions.
  • To determine if graft revision improves patency after thrombectomy.
  • To assess the impact of routine fistulogram on dialysis graft longevity.

Main Methods:

  • Retrospective review of 192 thrombectomy procedures in 61 patients.
  • Comparison of outcomes between a group with routine fistulogram (Group I) and a group without (Group II).
  • Analysis of lesion identification rates and graft patency based on intervention.

Main Results:

  • Routine fistulogram identified significant lesions in 78% of cases, compared to 57% with clinical findings alone (P < 0.05).
  • Assisted primary patency was significantly increased when revision was performed (4.84 months) versus no revision (2.9 months) (P < 0.05).
  • Routine fistulogram increased the likelihood of encountering significant stenosis.

Conclusions:

  • Routine fistulogram post-thrombectomy aids in identifying critical graft lesions.
  • Graft revision following fistulogram significantly improves assisted primary patency.
  • Routine fistulogram is recommended to enhance arteriovenous dialysis graft longevity.

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