Assessing the approach to a thrombosed AV graft

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• Vascular access (VA) patency is critical for hemodialysis patients.
• Arteriovenous (AV) grafts experience higher thrombosis rates compared to fistulas.
• Graft thrombosis necessitates timely and effective treatment strategies.

Purpose of the Study:

• To compare the success rates of surgical intervention versus percutaneous transluminal angioplasty (PTA) for treating thrombosed AV grafts.
• To evaluate the primary and unassisted patency of grafts treated with either surgical revision or PTA.
• To determine the optimal treatment strategy for AV graft thrombosis.

Main Methods:

• A retrospective observational study analyzing 336 thrombosed AV grafts over 18 months.
• Comparison of surgical thrombectomy (228 cases) versus endovascular PTA (126 cases).
• PTA techniques included Pharmaco-Mechanical and Arrow-Trerotola Device, performed as outpatient procedures.

Main Results:

• Immediate success rates were 100% for surgery and 87.3% for PTA.
• Unassisted patency favored surgery (265.12 days) over PTA (230.59 days).
• Primary patency at 30, 90, and 180 days favored PTA (74.1%/81%, 63.2%/67.5%, 53.9%/55.6% respectively).

Conclusions:

• Both surgical and endovascular PTA are viable options for managing AV graft thrombosis.
• PTA offers superior long-term primary patency for thrombosed AV grafts.
• The choice between surgery and PTA should consider immediate versus long-term patency goals.