Comparative outcome of patch angioplasty versus balloon angioplasty after surgical thrombectomy of thrombosed arteriovenous hemodialysis graft: 18-month results

Abstract

Background Repeated interventions to keep the well-functioning dialysis vascular access represent the Achilles heel for hemodialysis patients. Thrombosed permanent dialysis access, either arteriovenous fistula or arteriovenous graft (AVG) remains one of the most common and debatable complications regarding frequency of occurrence and how to manage. Objective Our study aims to evaluate mid-term outcomes of surgical thrombectomy of clotted AVG with adjunctive venous outflow procedures mainly patch angioplasty versus balloon dilatation to restore their function regarding patency as primary endpoint and safety as secondary endpoint. Patients and methods Between May 2016 and April 2019, 96 of 125 patients with first-time thrombosed dialysis AVGs were prospectively evaluated after block randomization for surgical patch angioplasty (group A) versus balloon angioplasty (group B) for venous anastomotic side after surgical thrombectomy in four tertiary referral hospitals in Egypt. Results Over 18-month follow-up period of our enrolled patients, immediate technical success was 100% with regaining graft functionality in 100% of 45 patients in group A patients versus 89.6% (P=0.056) in group B with achieving optimum graft functionality in 100% of technically successful declotting procedures (43 patients) in group B. The primary patency at 6, 9, 12 and 18 months in group A was 66, 63.6, 52.3 and 31.8%, respectively, versus 48.8, 48.8, 37.2 and 18.6%, respectively, in group B. The secondary patency in group A at 6, 9, 12 and 18 months was 86.4, 100, 88.6 and 77.3%, respectively, versus 72.1, 90.7, 79.1 and 69.8%, respectively, that was not statistically significant except 12-month primary patency (P=0.014). Conclusion Our study found no statistically significant difference in 18-month outcomes between patients treated with surgical thrombectomy with patch angioplasty and surgical thrombectomy with balloon angioplasty for thrombosed AVGs regarding regaining functionality and patency, however patients treated with balloon angioplasty required more additional secondary interventions and most of them were to manage graft venous anastomotic site restenosis.