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Time to thrombectomy is associated with increased risk for dialysis catheter placement

Damian Hall1, Daniel Shaughnessy2, Paul Drawz1

  • 1Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

Journal of Renal Care
|August 27, 2019
PubMed

Insights

Delaying dialysis access thrombectomy significantly increases the risk of needing a catheter. Even a one-day delay nearly doubles the likelihood of catheter use for hemodialysis patients.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Dialysis Access Management

Background:

  • Arteriovenous fistulae (AVF) and grafts (AVG) are prone to thrombosis, impacting dialysis access survival.
  • Prompt thrombectomy is crucial for maintaining access patency.
  • Catheter use for hemodialysis is linked to increased morbidity and mortality compared to AVF/AVG.

Purpose of the Study:

  • To investigate the association between delayed thrombectomy and the risk of dialysis access loss.
  • To determine if delayed thrombectomy leads to subsequent placement of a dialysis catheter.

Main Methods:

  • Retrospective analysis of 444 patients undergoing thrombectomy for dialysis access dysfunction (2008-2015).
  • Included 122 hospital admissions primarily for thrombectomy.
  • Statistical adjustment for prior interventions, access type, and time to thrombectomy.

Main Results:

  • A one-day delay in thrombectomy was associated with a twofold increase in the requirement for a dialysis catheter at discharge.
  • This increased risk for catheter use persisted at 6 months and any time after discharge.
  • The study included patients with arteriovenous fistulae and grafts, with a mean thrombectomy time of 10.8 hours.

Conclusions:

  • A single day delay in thrombectomy significantly elevates the risk of requiring a dialysis catheter.
  • This finding highlights the importance of timely intervention for dialysis access thrombosis.
  • The increased risk of catheterization persists long-term after the initial event.
Abstract

Keywords:
Arteriovenous fistulaArteriovenous graftDialysis catheterThrombectomy

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