Success Rate of Salvage Surgical Intervention of Acutely Thrombosed Arteriovenous Fistula in Hemodialysis Patients

Abstract

Background: Establishing and maintaining vascular access for hemodialysis in end stage renal disease (ESRD) patients are important prognostic factors for patient survival. The loss of vascular access, most frequently due to thrombosis, remains one of the most challenging obstacles in their long-term management. Success rate of surgical intervention of the vascular access in patients with acutely thrombosed arteriovenous fistulas (AVF) is still a controversial issue. Objective: To assess the success rate of salvage of acutely thrombosed arteriovenous fistula through surgical intervention. Patient and Methods: Uncontrolled clinical trial, was conducted over the period from November 2018 to `October 2019 on 52 patients with acute thrombosis of autogenous AVF in Suez Canal University Hospital. Patients were treated using open thrombectomy with or without surgical interventions as jump graft or re-insertion of anastomosis to correct juxta-anastomosis stenosis or re-anastomosis if needed regarding the cause. Results: The mean age was 51 +/- 14 years. The cause of thrombosis was stenosis in 13 patients (25%). Surgical intervention was successful to regain immediate functioning AVF in 34 patients (65.4%). The secondary patency rate after intervention was more than 6 months in 29 patients (85.3%). Jump graft with surgical thrombectomy in treatment of stenosis as a cause of thrombosis was the highest rate success in 8 patients (88.9%). Conclusion:Intervention with different surgical modalities for acutely thrombosed AVFs is a safe and effective procedure in many cases. It is associated with good success rates, low complication rates, and maintained long-term patency of vascular access.