Surgical Thrombectomy of Thrombosed Arteriovenous Grafts by Interventional Nephrologists

Abstract

The aim of our retrospective study was to present the success of surgical thrombectomy in acutely thrombosed, arteriovenous (AV), expanded polytetrafluoroethylene (ePTFE) grafts. Patients from hemodialysis centers in Slovenia were admitted to our dialysis center after acute thrombosis of their AV graft to undergo surgical thrombectomy under local anesthesia as an outpatient procedure. In 55 chronic hemodialysis patients, of whom 26 were men (47.3%), with a mean age of 63 ± 13 years (range 35-84 years), and diabetes mellitus in 11 patients (20%), 59 ePTFE AV grafts thrombosed. A total of 129 thrombectomies were performed, on average 2.2 ± 2.1 per graft (range 1-13). Primary patency (defined as the time from AV graft creation to first thrombosis) was 638 ± 633 days (range 10-2586, median 418 days), secondary patency (defined as the time from first thrombectomy to abandonment) was 451 ± 472 days (range 0-1994, median 305 days), and cumulative patency (defined as the time from creation to abandonment) was 1089 ± 685 days (range 25-3020, median 1031 days). In 46 (78%) of the AV grafts, the first thrombectomy was successful. The secondary patency rates after 1, 2, 3, 4, and 5 years were 76%, 66%, 54%, 14%, and 14%, respectively (13/59 unsuccessfully thrombectomized grafts were excluded). Cumulative patency after 1, 2, 3, 4, and 5 years was 88.1%, 67.8%, 44.7%, 27.1%, and 16.9%, respectively. In conclusion, surgical thrombectomy after thrombosis of an AV graft in the arm or thigh, performed by interventional nephrologists and followed, if required, by angioplasty, significantly prolonged the patency of the majority of thrombosed AV grafts.