Abstract No. 67 Spontaneous and assisted recanalization of hemodialysis access after prior failed thrombectomy and abandonment: the Lazarus phenomenon

Abstract

To evaluate the occurrence of spontaneous and assisted recanalization of hemodialysis accesses following failed percutaneous mechanical thrombectomy and abandonment of the access Materials and Methods: A retrospective review was performed of a prospectively managed quality assurance database of all hemodialysis (HD) access interventions performed between March 2001 and September 2020. Of 11,266 hemodialysis access interventions, 3,137 thrombectomy procedures were performed. Successful thrombectomy procedures were performed in 2,891 cases for an overall success rate of 92.2%. A total of 246 failed thrombectomy procedures were identified. An access was considered abandoned if no further attempts at thrombectomy were planned. Cases in which thrombectomy was recorded as failure due to other issues such as procedure complication but not considered abandoned, with planned subsequent return for repeat attempt, were excluded from analysis. Retrospective review of all failed thrombectomy procedures was performed to evaluate for a subset of accesses deemed abandoned that demonstrated spontaneous or assisted recanalization. Results: Of the 246 failed mechanical thrombectomy procedures, access types included 99 native fistulas, 120 grafts, 9 hybrid access, and 18 without documented access details. There were 14 accesses (5.7% of failures) that demonstrated recanalization enabling subsequent salvage of the access after failed thrombectomy and access abandonment; all accesses exhibited trace flow beyond the (arterial) anastomosis at the time of failed thrombectomy. Of these salvaged accesses, 9 occurred in fistulas, 4 in grafts, and 1 in a hybrid access. Secondary procedures were performed in 7 patients including repeat thrombectomy with angioplasty (n ¼ 3), thrombectomy with stent (n ¼ 1), angioplasty (n ¼ 1) and stent (n ¼ 1) to maintain access function. Seven of the cases demonstrated spontaneous recanalization with no required additional intervention. All 14 salvaged accesses were successfully used for hemodialysis within 30 days post spontaneous or assisted recanalization. Conclusions: Spontaneous recanalization of clotted hemodialysis accesses considered abandoned after failed mechanical thrombectomy can occur. Further characterization of this phenomenon is needed to determine whether an observation period of catheter HD is warranted in the subset of patients with trace flow beyond the anastomosis following failed thrombectomy.