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J Vasc Surg. 2018 Apr;67(4):1217-1226. doi: 10.1016/j.jvs.2017.08.072. Epub 2017 Nov 2.

Timely thrombectomy can improve patency of hemodialysis arteriovenous fistulas.

Author information

1
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
2
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
3
Department of Nursing, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
4
Division of Nephrology, Department of Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
5
Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
6
Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan. Electronic address: chihchengwumd@gmail.com.
7
College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.

Abstract

OBJECTIVE:

The urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis.

METHODS:

A before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution. Data about thrombectomy procedures, performed within 1 year before and after the initiative was introduced, were abstracted from an electronic database. Immediate outcomes and patency outcomes were compared between the preinitiative (control) and postinitiative (intervention) groups.

RESULTS:

During the study period, 329 patients were enrolled, including 165 cases before and 164 cases after the initiative. The intervention group had more thrombectomy procedures performed within 24 hours (93% vs 55%; P < .01) and within 48 hours (97% vs 79%; P < .01) than the control group. No between-group differences in procedural success or clinical success rates were found. At 3 months, the intervention group had a higher postintervention primary patency rate than the control group, although this did not reach statistical significance (58% vs 48%; P = .06). After stratification into native or graft accesses, the patency benefit was observed in the native access group (68% vs 50%; P = .03) but not in the graft access group (50% vs 46%; P = .65). After adjusting for potential confounders, timely thrombectomy remained an independent predictor of postintervention primary patency (hazard ratio, 0.449; 95% confidence interval, 0.224-0.900; P = .02) for native dialysis accesses.

CONCLUSIONS:

Our results suggest that a timely thrombectomy approach, in which salvage is attempted within 24 hours of thrombosis diagnosis, improves postintervention primary patency of native but not graft accesses for dialysis.

PMID:
29103931
DOI:
10.1016/j.jvs.2017.08.072
[Indexed for MEDLINE]

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