Salvage of Thrombosed Arteriovenous Access: Outcomes from a Dedicated Vascular Access Center

Vascular access thrombosis is the leading cause of arteriovenous (AV) access loss in hemodialysis patients, yet the optimal treatment strategy remains debated. This study evaluates outcomes of approach of AV access thrombosis in a specialized vascular access center.

Retrospective cohort study including all patients with thrombosed AV fistula (AVF) or AV graft (AVG) referred from 8 dialysis units between 2017 and 2021 to a dedicated, exclusively focused vascular access center with integrated surgical-endovascular capabilities. Technical and clinical success, stenosis pattern, and access-specific outcomes were evaluated. Primary, assisted primary, and secondary patency at 3, 6, and 12 months were analyzed using Kaplan-Meier methods.

A total of 152 patients were included with a mean age was 71.5 ± 12.9 years; 65.1% were male. Thrombosis incidence increased from 5.5% pre-coronavirus disease (COVID) to 9.6% during the pandemic (P = 0.04). Open thrombectomy was performed in 90.8% of cases; percutaneous thrombectomy in 3.3%, with a 40% cross-over rate to open technique. Outflow stenosis was identified in 76.3%; high-pressure balloon angioplasty was the most common adjunct (85.4%). Clinical and technical success rates were 91.2% and 89.2%, respectively. Global 3-month primary patency was 78.3%, significantly superior for autologous AVF versus AVG or compound AVF (P < 0.01). At 6 months, primary patency was 67.1% and primary assisted patency was 74.3% and at 12 months primary patency was 50.0% and primary assisted patency was 58.6%. The median follow-up duration was 720 days (23.6 months).

A dedicated vascular access center with integrated hybrid capabilities and experienced vascular surgeons providing daily availability achieved high outcomes in thrombosed AV access salvage, exceeding published benchmarks. This model emphasizes the critical importance of specialization, accessibility, and integrated surgical-endovascular expertise in managing dialysis access emergencies to ensure that AV access thrombosis is not an end point but a manageable complication.