4:00 PM Abstract No. 237 Lysis-assisted balloon thrombectomy: a declotting method for the treatment of thrombosed arteriovenous dialysis grafts: results from a retrospective analysis of 241 endovascular procedures

Abstract

This is a retrospective single-center analysis investigating the results of a percutaneous lysis-assisted balloon (LAB) thrombectomy procedure for the treatment of thrombosed arteriovenous dialysis grafts (AVGs). From January 2012 to Decmber 2016 (5 years), 291 declotting procedures were performed for the treatment of thrombosed dialysis arteriovenous fistulas or grafts. Data were available for 129 patients (75 men, 58.1%) with an AVG, undergoing 241 procedures [1.87 procedures/patient (1-10)]. Procedure includes initial lysis with 5-mg recombinant tissue plasminogen activator followed by thrombectomy with a high-pressure balloon for thrombus maceration using “facing sheaths” technique. 61 patients had ≥2 declotting procedures. In 80 cases (80/241; 33.2%) a stent graft (SG) was used for treatment of persistent stenosis. Main primary outcome measures were clinical success and postintervention assisted primary patency (PAPP). Secondary outcome measures included procedural complications and investigation of independent factors that could influence circuit survival. Median PAPP was 434 days according to Kaplan Meier survival analysis. Clinical success was 96.26%. In 6 cases (6/241, 2.49%) declotting failed and a catheter was placed. There were 16 minor (16/241, 6.64%) and no major complications. There was no significant difference in circuit survival regardless of SG use (No SG 406 days vs. SG 349 days; p = 0.24). There was a significant difference in favor of the 2nd declotting compared to the 1st in 61 patients (1st: 162 days vs. 2nd: 447 days; p<0.0001). LAB thrombectomy resulted in high circuit survival rates with increased technical success and minimum complications without the use of thrombectomy devices.