Impact on Pulmonary Arterial Pressures after Repeated Endovascular Thrombectomy of Dialysis Grafts: A Prospective Follow-up Study

Abstract

PurposeVascular access thrombosis is a common complication of arteriovenous dialysis grafts that results in silent pulmonary embolism (PE) in a substantial proportion of patients. However, the impact of repeated PE on the pulmonary vasculature remains unclear. Materials and MethodsFrom January 2010 to April 2012, 110 patients undergoing maintenance hemodialysis via arteriovenous grafts were recruited. Hemodynamic assessments, including transthoracic echocardiography and right heart catheterization, were performed at baseline and after 1 year to evaluate the changes in pulmonary artery (PA) pressures and heart function. ResultsFifty-two patients completed the follow-up hemodynamic assessment at a median duration of 535 days and had at least one endovascular thrombectomy procedure (median of seven). There was no significant difference in mean PA pressures between baseline and the end of follow-up (23.1 mm Hg ± 6.8 vs 21.6 mm Hg ± 6.1; P = .16). The change in mean PA pressure did not correlate with the number of thrombectomy procedures in the overall cohort (r = −0.02, P = .89) or in the subgroup with cardiopulmonary disease (r = −0.30, P = .14). The changes of mean PA pressure were not associated with number of thrombectomy procedures (β = −0.03, P = .89). ConclusionsRepeated endovascular thrombectomy procedures are not related to changes in PA pressure in the short term. The present results support the safety of endovascular thrombectomy in the pulmonary vasculature.