Endovascular Thrombectomy of Arteriovenous Dialysis Access: A Feasible Treatment?

Abstract

Introduction: There is no single best treatment for arteriovenous vascular access thrombosis, with comparable patency rates for both surgical and endovascular treatment. This study aims to evaluate the results of endovascular thrombectomy in our center and analyze the patency rates in different groups.

Material and methods: We retrospectively selected patients referred to our vascular access treatment unit due to arteriovenous access thrombosis from June 2017 to February 2022. All patients were submitted to endovascular manual thromboaspiration. Patient demographic data, comorbidities and clinical data were collected from medical records for further analysis.

Results: Out of the 96 patients selected, 45 (47%) had AV grafts and 51 (53%) had AV fistulas. The mean age was 74 (±15) years and 54% were males. The overall success rate of interventions was 85.4% (n = 82), while the reintervention rate stood at 59.8% (n = 49). AV grafts exhibited superior secondary patency compared to AV fistulas (92.4% vs. 78.0% and 85.3% vs. 74.1% at 6 and 12 months, respectively; p = 0.047). Forearm fistulas demonstrated enhanced primary patency (72.7% vs. 41.5% and 58.2% vs. 23.1% at 6 and 12 months, respectively; p = 0.017), better assisted primary patency (81.8% vs. 55.8% and 81.8% vs. 42.0% at 6 and 12 months, respectively; p = 0.025), and a lower reintervention rate (27.3% vs. 63.3%; p = 0.040) compared to upper arm fistulas.

Conclusions: Endovascular manual thromboaspiration seems to be an alternative technique for salvaging thrombosed vascular accesses. Forearm fistulas had the best assisted primary patency, which consolidates the rationale of giving primacy to its construction over other options.