Surgical Thrombectomy for Thrombosed Dialysis Grafts: Comparison of Adjunctive Treatments

Abstract

Vascular surgeons often encounter dialysis graft failure in hemodialysis patients during their daily practice. Despite advances in percutaneous treatment, there remains a role for surgical thrombectomy of thrombosed dialysis grafts. This study was designed to investigate the long-term outcome of dialysis graft thrombectomy and to examine the indications for and effectiveness of therapies adjuvant to Fogarty thrombectomy. Surgical outcomes of 590 consecutive dialysis graft thrombectomies performed between 2001 and 2003 were retrospectively reviewed. The 590 cases were classified into four groups based on the procedure performed adjuvant to Fogarty thrombectomy: group A, surgical thrombectomy by Fogarty thrombectomy catheter alone; group B, thrombectomy plus intraoperative angioplasty of graft outlet; group C, thrombectomy plus sequential balloon angioplasty in subsequent intervention; group D, thrombectomy plus graft outlet surgical revision. Age, gender, co-morbidity, and primary patency of grafts were reviewed and analyzed. The four groups exhibited similar demographic features and comorbidities (p>0.05). Mean primary patency in the four groups was 1.99+/-4.02, 7.21+/-7.61, 8.35+/-9.53, and 7.26+/-6.99 (months), respectively. Survival curves for each group were determined by Kaplan-Meier methods. Primary patency in group A was statistically inferior to all of the other three groups, whereas groups B, C, and D did not significantly differ with regard to graft patency. Surgical thrombectomy alone is inadequate for treating a thrombosed dialysis graft. The underlying graft outlet stricture requires direct surgical revision or balloon angioplasty during surgery or intervention in the angiography suite to ensure long-term patency of the graft.