ABSTRACT
Introduction: The key to treatment of a thrombosed dialysis graft is restoration and maintenance of function as long as possible. The objective of this study was to compare the outcomes of pharmacomechanical thrombolysis and surgical thrombectomy in the treatment of thrombosed haemodialysis grafts.
Materials and Methods: During a 3-year period, 108 patients with 114 thrombosed dialysis grafts were referred to our institute for treatment. Fifty thrombosed dialysis grafts underwent pulse-spray catheter thrombolysis using recombinant tissue plasminogen activator (rt-PA) with angioplasty, and 64 thrombosed dialysis grafts underwent surgical thrombectomy. The procedural success rates, complications and average patency times and patency rates were compared between the 2 procedures. P values less than 0.05 were considered to be statistically significant. Results: :There were no statistically significant differences between the pharmacomechanical thrombolysis group and the thrombectomy group in the procedural success rates (94% and 93.8%, P = 0.15) or average patency times (6.24 months and 6.30 months, P = 0.17). The primary and secondary patency rates at 12 months were 28.0% ± 8.4% and 54.3% ± 7.8% for the thrombolysis with angioplasty group, and 30.0% ± 6.3% and 57.0% ± 4.8% for the thrombectomy group, respectively (P = 0.65 and P = 0.49, respectively). There were no procedural-related major complications. Conclusion: : Our study found no differences in outcomes between patients treated with pharmacomechanical thrombolysis and surgical thrombectomy for thrombosed haemodialysis grafts. Pharmacomechanical thrombolysis can be considered as an alternative treatment for dialysis graft thrombosis.Permanent dialysis vascular access is the primary route for haemodialysis in patients with chronic renal failure, usually through an arteriovenous fistula (AVF) or an arteriovenous graft (AVG). The AVF has many advantages over synthetic grafts, including better patency, lower rates of infection and a lower incidence of vascular steal syndrome; however, the major problems are immaturity or a prolonged time for maturity. Although the patency rate of the AVG is lower than the AVF, it is still more widely used because it is easier to create and can be used earlier than AVF for haemodialysis. A thrombosed haemodialysis vascular access occurs frequently in a prosthetic graft. Salvage of a thrombosed haemodialysis graft is essential to maintain haemodialysis and prolong the quality of life. The traditional treatment of graft thrombosis is surgical thrombectomy with 1-year patency rates varying from 25% to 70 %. Currently, 2 percutaneous endovascular techniques are widely used for the treatment of thrombosed AVG, mechanical thrombectomy and pharmacomechanical thrombolysis. Mechanical thrombectomy is a procedure that uses a device for thrombus removal, which is faster than the pharmaceutical method. However, the thrombectomy device is expensive, and the procedure is not available in all institutions. Pharmacomechanical thrombolysis is a method to treat thrombosed haemodialysis grafts using a thrombolytic drug and balloon catheter. This method is easier to perform, and any experienced interventional radiologist can perform it. Several studies have reported 1-year patency rates of 57% to 69% with this method.
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