Arteriovenous Grafts Thrombectomy Salvage Procedures

Document Type : Original Article

Authors

1 Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

2 Department of Vascular Surgeon, Faculty of Medicine, Cairo University, Cairo, Egypt

3 Department of Nephrology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Abstract

Objective: Arteriovenous fistula (AVF) is the access of choice for hemodialysis. The thrombosis of a
definitive access for hemodialysis is an acute event that can interrupt dialysis treatment. The management of AVF thrombosis is usually the implantation of a catheter until the creation of a new access; causing depleting the patient’s vascular bed. We aimed to evaluate the efficacy of open and Angio-jet mechanical thromboectomy for salvage of failed or failing synthetic arteriovenous grafts
(AVGs). Materials and Methods: 90 thromboectomy procedures were done for AVGs from January
2008 to January 2012. Surgical thromboectomy was done for 60 cases and the other 30 were treated
by endovascular mechanical thromboectomy using Angio-jet machine. We classified our studied patients into two groups; Group A (underwent surgical thromboectomy) and Group B (underwent
endovascular thromboectomy). Results: 73 of the treated arteriovenous grafts (AVG) were completely thrombosed (failed accesses). Complementary angioplasty carried on for 66 cases (73.3%). 30 of
these 66-angioplasty group required stenting of the underlying stenosis. Primary technique success
was 95% (57/60) and 90.0% (27/30) for surgical and endovascular techniques respectively. Primary
patency rate follows up for one year showed no significant difference for both groups. No significant
difference in the complications rates between both techniques. The rate of restenosis and reintervention of the grafts and venous conduits is same in both stented and non-stent groups.
Conclusion: No superiority of surgical technique over the endovascular one in terms of the primary
technical success and for the mid-term patency rate. The endovascular technique could be preferred as
the incidence of hematoma development was less and no incision was needed. Primary stenting of
underlying venous stenosis is not recommended except in failure achievement of good venous outflow
after angioplasty or at recurrent stenosis after the primary intervention.

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