Fistulogram after Arteriovenous Dialysis Graft Thrombectomy Should be Mandatory

Abstract

The purpose of this study was to determine if fistulogram after prosthetic arteriovenous dialysis graft thrombectomy would reveal underlying lesions, which need correction, and if revision would improve graft patency. One hundred and ninety-two open thrombectomy procedures in 61 patients from January 1, 2000 to July 31, 2005 were reviewed retrospectively. All of the study patients were divided into two groups: In Group I fistulogram was carried out and in Group II no fistulogram was performed. Based on the fistulogram or clinical findings, appropriate intervention was carried out. In Group I, of 99 thrombectomy procedures, a significant lesion was identified and revision was carried out in 77 cases (78%). In Group II, of 93 thrombectomy procedures, a significant lesion was identified and revised in 53 cases (57%). A significant abnormality was more likely to be encountered by routine fistulogram than surgical exploration alone, 78 per cent versus 57 per cent (P < 0.05). Assisted primary patency is significantly increased in Group I and II when revision was performed (4.84 months) compared with when no fistulogram and no revision was performed (2.9 months), P < 0.05. Routine fistulogram after thrombectomy of an arteriovenous dialysis graft increases the likelihood of identifying a significant stenosis. Revision of the graft increases the longevity. We recommend routine use of fistulogram during thrombectomy.

Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft

“…We found significant lesions after open thrombectomy that need intervention to correct lesions more than 90% of cases. These data near the result in previous report (78%) from Kuma, et al 11 Regarding one-year primary patency rate, the 26% and 33% rates of one-year primary patency in the endovascular and open thrombectomy groups in our study were near the upper end of the range reported by Tordoir, et al (8-29% and 10-30%), and similar to the rate reported by Hongsakul, et al (28% and 30%).…”

“…Mostly of patients had total graft thrombosis, only 11 of 25 patients in the endovascular group presented with clinical partial graft thrombosis. Median time from graft thrombosis to treatment was 2 days (range: 1-14) in the endovascular group, and 1 day (range: [1][2][3][4][5][6][7][8][9][10][11][12][13][14] in the open thrombectomy group (p=0.078). A summary of patient and graft data is shown in Table 1.…”

Office-based endovascular suite is safe for most procedures

“…We and others have previously shown that access thrombosis is almost always the result of outflow stenosis, so monitoring for access failure and in-office correction should minimize missed dialysis sessions and lead to fewer catheters. 4,16 Studies have suggested that balloon-assisted maturation of the fistula may be beneficial. 3 We are still waiting to see more studies to confirm this approach before we start using it.…”