Ultrasound-Guided Pharmacomechanical Thrombolysis and Angioplasty for Treatment of Acute Thrombotic Prosthetic Arteriovenous Access: 5-Year Experience with 154 Procedures in a Single Center

Abstract

Pharmacomechanical thrombolysis (PMT) and percutaneous transluminal angioplasty (PTA) for the treatment of acute thrombotic prosthetic arteriovenous access (PAVA) are conventionally guided by radiography, which may cause radiation injury and requires the use of radiographic contrast media. The aim of the present study was to summarize our experience with ultrasound-guided PMT and PTA as an alternative to radiographic guidance. Between December 2012 and October 2016, 114 patients with acute thrombosis of PAVA were treated urgently with ultrasound-guided PMT and PTA to restore blood flow. The patients were followed up every 3 mo postoperatively. The 114 included patients underwent 154 episodes of ultrasound-guided PMT and PTA and were followed up for a mean of 20.7 ± 9.1 mo. The technical success rate was 91.6%, and the clinical success rate was 97.4%. Post-intervention-assisted primary patency rates at 3, 6, 12 and 24 mo were 90.8%, 78.8%, 66.3% and 50.9%, respectively. Post-intervention secondary patency rates at 3, 6, 12 and 24 months were 96.3%, 94.5%, 90.6% and 85.4%, respectively. PMT and PTA for the treatment of PAVA were performed successfully under the guidance of ultrasound with a success rate similar to that under radiographic guidance, thus avoiding radiation injury and contrast medium use, although close surveillance and timely intervention are imperative to ensure long-term patency.