Abstract No. 545 Effect of multiple patient specific and procedure related factors on patency of dialysis access after declotting procedure

Abstract

To determine effect of multiple patient specific and procedure related factors on re-thrombosis of arteriovenous dialysis access that underwent declotting procedure by interventional radiology. Consecutive patients that underwent declotting of thrombosed arteriovenous dialysis access were enrolled. Multiple variables including patient’s demographics, comorbidities, and procedure related technical factors were recorded. The effects of these variables on re-thrombosis of the dialysis access during the 12months follow-up period was determined. A total of 111 consecutive patients (age: 61.5 ± 16.9 years, female 47%, male 53%; race: 80% African American, 18% white American, other 2%) were enrolled. Main underlying factors leading to renal failure were determined as DM 13%, HTN 25%, both 41% and other 21%. The access point included AV graft in 78% and AV fistula in 22%. Angiographic/technical declotting was not achieved in 30 (27%) patients at the time of initial declotting procedure. Patients demographic, underlying comorbidities, site or age of the dialysis access was not associated with initially successful angiographic/technical declotting (P > 0.05). In patients with successful declotting (n = 81, 71%), a combination of pharmacologic and mechanical thrombolysis with balloon angioplasty was utilized. 26 (32%) patients had existing vascular stent and in 5 (6%) patients a new stent was deployed. In 9 (11%) patients mechanical thrombectomy device (AngioJet, Argon Cleaner, or Arrow-Trerotola) was used. During the follow-up period (data available in 75 of 81 patients), 27 (36%) patients had re-thrombosis of the access point. The rate of re-thrombosis was significantly higher in AV graft compared to AV fistula (41% vs. 13%, respectively; P < 0.5). Presence of stent or application of thrombectomy device was not associated with a statistically significant difference in re-thrombosis rate or patency period of the access after declotting procedure (rethrombosis rate: stent: 39% vs. no stent: 52%, thrombectomy device: 50% vs. no device: 34%, P > 0.05 for both; rethrombosis time: stent: 77.8 ± 105.5 days vs. no stent: 40.8 ± 43.4 days, thrombectomy device: 46.2 ± 21.6 days vs. no device: 54.3 ± 76.2 days, P > 0.05 for both). Although the presence or placement of vascular stent or application of thrombectomy device could help during initial declotting procedure, they may not be associated with patency rate and interval during the first 12-month follow-up interval.