Outcomes of arteriovenous grafts following simultaneous thrombectomy and stent graft placement across the venous anastomosis.

Abstract

Arteriovenous grafts (AVGs) suffer from high thrombosis rates. It is not known whether placement of stent grafts at the venous anastomosis (VA) of thrombosed AVGs would impact future thrombosis. This is a retrospective study evaluating a group of AVGs that underwent endovascular thrombectomy with placement of a stent graft at their VA. The study period was a minimum of 1year or until kidney transplantation or death. Primary and secondary AVG patency rates were obtained using Kaplan-Meier survival estimates. Demographic parameters were analyzed using Cox multivariate analysis. The effect of early vs. late first thrombosis was also studied. Sixty-six patients were included in the study. Of these, 53 (80%) experienced ≥1 thrombotic event during the study period. Thrombosis led to AVG loss in 26 (39%). The primary patency was 47%, 35%, and 21% at 3, 6, and 12months, respectively. The assisted primary patency was 50%, 38%, and 25% at 3, 6, and 12months, respectively. The secondary patency rate was 85%, 76%, and 72% at 3, 6, and 12months, respectively. Thus, poor primary patency rates were observed despite stent graft placement at the VA. In addition, early thrombosis following stent graft placement was associated with worse AVG outcomes.