Abstract
The use of arteriovenous graft is indicated in patients if the subcutaneous venous bed is exhausted or unsuitable for arteriovenous fistula creation. The leading cause of failure of a prosthetic arteriovenous hemodialysis-access graft is venous anastomotic stenosis causing thrombosis of the graft. A number of surgical techniques and endovascular tools have been used to treat this stenosis and thrombosis. None have yet proven to be ideal. This study was designed to evaluate the results of hybrid treatment of arteriovenous graft thrombosis associated with venous anastomotic stenosis. Over the period 2013-2014, we treated 16 AVG occlusions. Immediately after the diagnosis of occlusion was made, the patients underwent thrombectomy using a Fogarty catheter. After thrombectomy, a diagnostic fistulogram was performed and if VAG stenosis was confirmed, it was treated with balloon angioplasty and stent graft introduction. Lesions were dilated to reduce the stenosis in the treated area to less than 25%. Primary patency after 12 months was 32.8%. Primary assisted patency was 44.7%, secondary patency was 47.6%. Restenosis of the stent graft was seen in two patients. Recurring AVG occlusion was observed in four patients. The average number of interventions to maintain AVG patency was 1.18 per patient/1 year of dialysis. Treatment of AVG thrombosis due to VAG stenosis by hybrid procedure proved to be effective and improved secondary patency.
Highlights
Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients
Their great disadvantage is their propensity for venous outflow stenosis (VAG stenosis = venous anastomosis of the graft) caused by endothelial and fibromuscular hyperplasia
This study evaluates the results of a hybrid treatment of arteriovenous graft thrombosis associated with venous anastomotic stenosis
Summary
Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients. Prosthetic arteriovenous grafts (AVG) are indicated in patients with failed arteriovenous fistula or inappropriate vessels. Advantages of ePTFE grafts include short maturation time and multiple potential access sites. AVGs are associated with a greater morbidity than autogenous fistula. Their great disadvantage is their propensity for venous outflow stenosis (VAG stenosis = venous anastomosis of the graft) caused by endothelial and fibromuscular hyperplasia. Stenosis at VAG, leading to thrombosis, is the primary cause of vascular access failure. This study evaluates the results of a hybrid treatment (minimally invasive surgery plus endovascular treatment; stent graft) of arteriovenous graft thrombosis associated with venous anastomotic stenosis
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