Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

Abstract

Background. To investigate the safety, feasibility, efficacy, and long-term patency rate of manual declotting under duplex ultrasound (US) guidance followed by percutaneous transluminal angioplasty (PTA) in thrombosed native arteriovenous fistulas (AVFs). Methods. Of 87 consecutive thrombosed AVFs evaluated by duplex US, 22 patients with 25 recently thrombotic events in 22 AVFs were suitable for manual declotting. PTA was performed following successful declotting, and long-term patency was assessed. Results. The procedure success rate of manual declotting was 80% (20 of 25), and a residual stenosis of 74 ± 9% was identified by duplex US after declotting. PTA reduced the diameter stenosis to 25 ± 6% and increased the lumen diameter from 1.33 ± 0.85 mm to 4.62 ± 0.98 mm. Neither embolic nor bleeding complications were noted during the procedure. The average procedure time and the fluoroscopy time were 28.4 ± 9.9 and 7.2 ± 4.1 minutes, respectively. Primary patency rates at 1, 2, and 3 years were 47%, 35%, and 28%; assisted primary patency rates at 1, 2, and 3 years were 71%, 63%, and 63%; and secondary patency rates at 1, 2, and 3 years were 76%, 71%, and 63%, respectively, during a maximum follow-up period of 42 months. Conclusion. The combination of duplex US-guided manual declotting and angioplasty of underlying stenosis is a safe and feasible method to treat recently thrombosed native AVFs in selected patients. It simplifies the interventional procedure, reduces cost and radiation exposure time, and extends life span of dialysis fistula with acceptable long-term patency rate.

Ultrasound as a Tool for Preoperative Planning, Monitoring, and Interventions in Dialysis Arteriovenous Access

“…The degree of residual stenosis after angioplasty can be measured with ultrasound [13]. Bacchnini et al [14] found that after successful angioplasty of venous stenoses, access blood flow measured by ultrasound increased dramatically and returned to baseline flow values obtained before a stenosis had developed.…”

A national study of autogenous arteriovenous access use and patency in a contemporary hemodialysis population

“…In particular we had access to all radiological procedures and we were able to characterize the exact location and the intervention performed in all dysfunctional AV accesses. AV access thrombosis treatment success can range from 88 to 100%, with post-intervention primary patency rates ranging from 9% to 49% at 1 year [22][23][24] . In our study, primary patency following treatment of thrombosis was 49% (22-71) at 1 year, however the difference between primary-assisted and secondary patency was only 2%.…”

Endovascular Salvage for Thrombosed Hemodialysis Access

“…Immediate significant recoil of the stenosis should be further addressed by prolonged balloon angioplasty, cutting balloon, stenting, or even direct surgical revision so as to ensure a durable result of the procedure. Some adjuvant maneuvers such as manual declotting without or with ultrasound guidance, 13 suction thrombectomy through a mini-venotomy, or irrigation with lytic solution (250 KU urokinase in 10 ml of normal saline) may sometimes be helpful in difficult procedures.…”