Different Modalities for Management of Thrombosed Arteriovenous Fistula: Multicenter Experience

Document Type : Original Article

Authors

1 Department of vascular Surgery, Faculty of Medicine, Ain Shams University, Egypt

2 Department of General Surgery, Faculty of Medicine, Benha University, Egypt

Abstract

Introduction: This study aims to report and evaluate different declotting modalities with their outcomes for
salvage of thrombosed native dialysis access.
Patients and methods: Between March 2023 to March 2024, 70 patients with first time thrombosed native
arteriovenous fistula (AVF) were recruited, 27 radio-cephalic, 20 brachio-cephalic and 23 brachio-basilic AVFs were
treated either surgically with thrombectomy or endovascularly using different endovascular declotting concepts.
Patients had follow-up at 1 week, 1, 3 and 6 months postoperatively.
Results: In our study 15.7% (n=11/70) were treated with open thrombectomy and 84.3% (59/70) were
treated endovascularly using 5 different techniques. Techniques used were open surgical thrombectomy, balloon
maceration, pulse spray thrombolysis, mechanical thrombectomy (Aspirex device), aspiration thrombectomy
(Penumbra device) and rheolytic mechanical thrombectomy (Angiojet device). Clinical success achieved in each
group was 72.7%, 70%, 69.2%, 100%, 100% and 90.9% respectively (p=0.175), with 6-month primary patency
72.7%, 60%, 69.2%, 75%, 77.8% and 86.4%, respectively (p=0.629).
Conclusions: Surgical and endovascular intervention for thrombosed AVFs have comparable early clinical success
and short-term primary and secondary patency rates.

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