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Results of the endovascular treatment system for occluded native arteriovenous fistula
Christopher Cheang Han Leo1, Gabriel Cassorla2, Jan Swinnen3
1University Medicine Cluster, Division of Nephrology, National University Hospital, Singapore.
Insights
Endovascular Treatment System effectively revives occluded arteriovenous fistulas in hemodialysis patients. This safe and viable technique demonstrates good long-term patency rates for vascular access.
Area of Science:
- Vascular Surgery
- Interventional Nephrology
- Endovascular Interventions
Background:
- Arteriovenous fistula (AVF) is the standard vascular access for long-term hemodialysis.
- Occlusion of native AVFs necessitates effective management strategies to maintain dialysis access.
Purpose of the Study:
- To present the techniques and outcomes of a developed Endovascular Treatment System for managing occluded native AVFs.
- To evaluate the efficacy and safety of endovascular recanalization for thrombosed AVFs.
Main Methods:
- Retrospective chart review of 130 patients with occluded native AVFs undergoing attempted recanalization.
- Analysis of intervention techniques including angioplasty, stenting, and incisional thrombectomy.
- Assessment of primary, assisted, and secondary access patency rates at various time points.
Main Results:
- High post-intervention primary access patency: 83.8% at 6 months, decreasing to 59.6% at 3 years.
- Excellent secondary patency rates, especially in fistulas-in-use: 91.1% at 6 months, 74.6% at 3 years.
- No significant difference in access survival or patency between incisional thrombectomy and angioplasty with or without stenting.
Conclusions:
- Endovascular techniques are a viable and safe option for reviving thrombosed autologous arteriovenous fistulae.
- The developed Endovascular Treatment System offers a successful approach to restore vascular access in hemodialysis patients.
- Recanalization of occluded AVFs using endovascular methods can effectively prolong the usability of vascular access.
Background:
Arteriovenous fistula is the definitive vascular access for patients on long-term haemodialysis. The aim of this study is to present the techniques and results of the Endovascular Treatment System that we have developed for managing the occluded native arteriovenous fistula.
Methods:
The current study is a retrospective chart review on all patients who presented with an occluded native arteriovenous fistula and underwent attempted recanalization between 1 January 2005 and 31 December 2014.
Results:
A total of 130 patients were included in the study. Post-intervention primary access patency was 83.8% at 6 months, 78.7% at 12 months, 64.6% at 2 years and 59.6% at 3 years. Post-intervention assisted access patency in fistulas-in-use was 86.5% at 6 months, 81% at 12 months, 66.8% at 2 years and 61.2% at 3 years. Post-intervention secondary patency for all cases was 84.7% at 6 months, 80.2% at 12 months, 66.1% at 2 years and 62% at 3 years. Post-intervention secondary patency in fistula-in-use was 91.1% at 6 months, 90% at 12 months, 85% at 2 years and 74.6% at 3 years. Access survival nor patency differed significantly when incisional thrombectomy was compared to angioplasty with or without stenting with access survival of 91.2% and 92.5% at 12 months and access patency of 82.9% and 89.7% at 12 months (P = 0.834 and P = 0.898, respectively).
Conclusions:
In autologous arteriovenous thrombosed fistulae, the use of endovascular techniques to revive the access is a viable and safe technique to employ in most cases.
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