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Comparison of surgical and radiological interventions for thrombosed arteriovenous access.

Lambert, Gary and Freedman, Jonathan and Jaffe, Susan and Wilmink, Teun (2018) Comparison of surgical and radiological interventions for thrombosed arteriovenous access. The journal of vascular access. ISSN 1724-6032. This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs

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Official URL: http://journals.sagepub.com/doi/abs/10.1177/112972...

Abstract

INTRODUCTION

To compare open surgical and radiological interventions for thrombosed arteriovenous access for dialysis.

METHODS

A retrospective analysis of access procedures and dialysis episodes from 1 December 2002 to 30 November 2015 with follow-up up to 1 August 2016. Hospital records and dialysis database interrogated for further interventions and length of functional use.

RESULTS

Some 128 surgical and 27 radiological thrombectomies were compared. Radiological treatment was successful in 24 (89%) cases and surgical interventions in 65 cases (51%; p < 0.001). In all, 82 (64%) of the 128 surgical thrombectomies had no additional treatment, 43 (34%) had a surgical revision and 3 cases (2%) had an on-table balloon angioplasty. All 27 interventional thrombectomies had an additional balloon angioplasty. Success rate was significantly increased after a surgical revision (74%) or balloon angioplasty (87%) compared to no adjuvant procedure (38%; p < 0.001). There was a trend towards higher primary failure rates of arteriovenous fistula thrombectomies in the upper arm (57%) compared to the arteriovenous fistula thrombectomies in forearm (40%) and arteriovenous graft thrombectomies (33%; p = 0.056). Assisted primary patency was better after interventional treatment compared to surgery (p = 0.02) and significantly better after thrombectomy with additional treatment (p = 0.005). Patency after surgical revision or balloon angioplasty of the access was similar (p = 0.15). More procedures were required to maintain the access after balloon angioplasty than after surgical revision, and intervention-free survival was better after surgical revision (p = 0.02).

CONCLUSION

Revision procedures significantly increase success rate of access thrombectomies. Radiological thrombectomies have higher success rates but lower intervention-free survival and need more additional procedures to maintain patency.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their HEFT Athens login IDs
Subjects: WN Medical imaging. Radiology
WO Surgery
Divisions: Planned IP Care > Vascular
Related URLs:
Depositing User: Miss Emily Johnson
Date Deposited: 09 Mar 2018 15:52
Last Modified: 09 Mar 2018 15:52
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1616

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