No abstract

Venous thrombus hardens with age; however, elastography pattern on RTE, in its present form, may not be able to differentiate acute DVT from subacute DVT.

Background: This study aims to compare success and patency rates of pharmacomechanical thrombectomy versus open surgical thrombectomy for thrombosed native arteriovenous fistulas. Methods: A total of 96 patients (56 males, 40 females; mean age 61±11.7 years; range, 26 to 82 years) with a thrombosed native arteriovenous fistula between January 2016 and December 2018 were retrospectively analyzed. The patients were divided into two groups as pharmacomechanical thrombectomy (n=42) and open surgical thrombectomy (n=54). Primary failure rate and primary patency rate at 6 and 12 months were recorded. Results: Of 42 patients in the pharmacomechanical thrombectomy group, 41 (98%) had additional interventions, and primary failure occurred in four patients (10%). Primary failure was seen in 15 (28%) patients in the surgical group. The primary patency rates at 6 and 12 months were significantly higher in the pharmacomechanical treatment group than the surgical group (85% vs. 67% and 78% vs. 55%, respectively; p<0.05). Conclusion: Pharmacomechanical thrombectomy procedure yields higher primary patency rates than open surgical thrombectomy for thrombosed native arteriovenous fistula.

Background: Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas. Methods: A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon – percutaneous transluminal angioplasty (n = 44) and plain balloon – percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24–75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon – percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon – percutaneous transluminal angioplasty group (p = 0.24). Results: There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon – percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01). Conclusion: Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

This analysis regarding arteriovenous fistula in octogenarian end-stage renal disease patients figured out equal death-censored cumulative patency compared to nonelderly, and two-year survival rate was acceptable. This study strengthens the argument that arteriovenous fistula should be the best proper choice in selected octogenarians; older age only should not be considered as an absolute contraindication for arteriovenous fistula creation in octogenarians; and patient-based approach should be applied.