Efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach

Abstract

Purpose: Compared with the conventional approach, the benefits of the transjugular approach in endovascular intervention for hemodialysis access avoids complications due to direct puncture and reduces direct radiation exposure to the hands of operator. The aim of this non-inferiority study was to evaluate the efficacy of the transjugular approach in endovascular intervention for hemodialysis access comparing with conventional approach. Methods: We retrospectively assessed endovascular intervention for hemodialysis access performed in our hospital from 2012 to 2016, divided into the conventional approach group and the transjugular approach group. The hemodialysis access survival rate, re-intervention survival rate, and lesion characteristics were comparatively evaluated. Results: We included 223 cases in 118 patients (146 cases with conventional approaches and 77 cases with transjugular approaches). There was a higher incidence of thrombosis with the conventional approach (p < 0.001), however, no significant difference in the hemodialysis access type or main lesion location. The transjugular approach showed either a better hemodialysis access survival rate (p = 0.017) and a trend toward improved re-intervention survival rate (p = 0.098) than the conventional approach. Following classification according to the presence of thrombus, there was no significant difference in either the hemodialysis access survival rate or the re-intervention survival rate between the approaches with or without thrombus. Conclusion: The transjugular approach could be performed in most cases and was similar to the conventional approach in terms of outcomes. The transjugular approach should be considered as an alternative to either replace or use in combination with the conventional approach in endovascular intervention for hemodialysis access.

Transjugular approach in aspiration thrombectomy and angioplasty of a thrombosed straight arteriovenous graft compared to the direct hemodialysis access approach

“…6 Lee et al reported that the transjugular endovascular approach could be performed successfully in most cases with similar outcomes compared with conventional endovascular approach. 7 The jugular vein receives a single vascular sheath, instead of one or two vascular sheaths in the graft with high blood flow; therefore, complications resulting from sheath insertion are expected to be reduced. Furthermore, the jugular vein approach enables aspiration thrombectomy and angioplasty for AVG using a single retrograde access route (from venous anastomosis to arterial anastomosis) without the creation of a dead space (a space where two antegrade and retrograde sheaths overlap in a graft, making it difficult to perform thrombectomy efficiently).…”

“…Lee et al reported that the transjugular endovascular approach could be performed successfully in most cases with similar outcomes compared with conventional endovascular approach 7 . The jugular vein receives a single vascular sheath, instead of one or two vascular sheaths in the graft with high blood flow; therefore, complications resulting from sheath insertion are expected to be reduced.…”