[Management of shunt thrombosis]

The shunt thrombosis is the most frequent complication of dialysis shunts in haemodialysis patients. Morphological reasons are the main causes of shunt occlusion. A critical evaluation of this aspect is presented on the basis of our own experience.

A retrospective study investigated our own procedure of 136 operations between 2007 and 2011 on occluded haemodialysis shunts of the arm. The patient population comprised 49 thrombosed Cimino shunts, 64 PTFE and 23 occluded venous shunts for haemodialysis within a period of four weeks. The thrombosed PTFE shunts showed a recurrence rate of 48 %. There was a maximum of 9 previous operations on renewed occluded shunts. For the patency rates, the reocclusions and the intraoperative abandoning of the shunt were added. Preoperative duplex and angiography were performed on average in 20 % all of the cases.

All of the occluded Cimino shunts were treated successfully by thrombectomy in addition to a new anastomosis (38 out of 49, 78 %). The thrombosed PTFE loops for thrombectomy alone in 6 of 11 cases (54 %) and with additive corrections of the anastomosis showed in conclusion a patency rate of 64 % (16 out of 25). A complete new shunt reconstruction of the occluded PTFE shunts was necessary in 14 cases (22 %) and achieved patency rate of 85 %. For the venous loops anastomosis corrections were successful in 8 of 11 cases (72 %). The complete new shunt reconstructions, over bypass procedures or graft interpositions showed the best statistically significant results (χ2 = 3.9; p < 0.05) in comparison to the other procedures. Concerning time management both the day Monday and the weekend were troublesome.

The creation of a new anastomosis is the preferred method in the treatment of an occluded Cimino shunt. The sole thrombectomy and correction of the venous anastomosis is often insufficient. The most important aspect in cases of occluded PTFE loops is a completely new shunt reconstruction including interposition and over bypass. The need to perform the operations in good time is obvious, but not necessary in every case at night.