Perioperative and Long-Term Outcomes after Percutaneous Thrombectomy of Arteriovenous Dialysis Access Grafts
Nkiruka Arinze, MD1, Tyler Ryan1, Rohit Pillai1, Rajendran Vilvendhan, MD2, Alik Farber, MD1, Douglas W. Jones, MD1, Denis Rybin, PhD3, Scott R. Levin, MD1, Thomas W. Cheng, MS1, Jeffrey J. Siracuse, MD1
Background:
Maintaining patency of arteriovenous dialysis grafts (AVG) is difficult secondary to low primary patency, the need for reintervention, and limited additional access options. Our goal was to assess our institution's experience with AVG percutaneous thrombectomy.
Methods:
We performed a retrospective analysis of all percutaneous thrombectomies for AVG performed between 2015 and 2017. These were generally performed using mechanical thrombectomy and occasional tissue plasminogen activator for the outflow, over the wire Fogarty balloon for inflow, and adjunctive inflow and outflow interventions as necessary. Perioperative outcomes, long-term patency, reinterventions, and need for new permanent access placement were analyzed.
Results:
There were 218 percutaneous thrombectomies performed on 88 AVGs in 77 patients. Approximately were 53.2% male sex and 68.8% were black race. Mean age was 61.1±13.0 years. At the time of thrombectomy, 73.8% underwent venous outflow interventions and 4.5% underwent arterial inflow interventions. Within 30 days, 20.6% of declotted grafts required a repeat percutaneous thrombectomy, 14.3% required a tunneled catheter placement, 4% had access site/graft infection, and 2.6% went on to surgical thrombectomy. There were no venous thromboembolic, cardiopulmonary, or cerebrovascular complications. One patient had arm ischemia and required embolectomy at the time of index procedure. After percutaneous thrombectomy, freedom from repeat thrombosis at 1 and 3 years was 48% and 25.5%; freedom from new dialysis access placement was 66% and 51%, respectively. Overall patient survival was 82% at 3 years.
Conclusion:
Percutaneous thrombectomy of AVGs is safe and is associated with acceptable patency rates. This less invasive method facilitates repeated reinterventions for these high-risk patients with limited dialysis access options.
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