Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion

Koraen-Smith, L.; Krasun, Matteus; Bottai, Matteo; Hedin, Ulf; Wahlgren, Carl Magnus; Gillgren, Peter

doi:10.1177/1129729818761277

Cited by 14 publications

(20 citation statements)

References 20 publications

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“…There are treatment methods of thrombotic occlusion in VA currently in the main stream such as surgical thrombectomy, thrombolysis device, thrombus fragmentation device or thrombus suction device, and so on. These methods show a good result for a long period as in the previous works, 5–10 but, except for surgical thrombectomy, they require medical treatment during the hyperacute phase after obstruction. Fragmentation will be impossible when time passed after obstruction as the thrombus degenerates and stiffens.…”

Section: Discussionmentioning

confidence: 62%

Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion

Wakabayashi¹

2019

J Vasc Access

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Introduction: As a countermeasure against the organized thrombi frequently observed in vascular access occlusion, we devised a percutaneous excision method for organized thrombi under superficial ultrasound guidance using biopsy forceps. The Radial JawTM 3 (2 mm) biopsy forceps of Boston Scientific Corporation was used. The usefulness of this method was investigated. Method: The following protocol, which is suitable for endovascular treatment, was prepared and used: (1) all procedures were performed under ultrasound guidance and (2) use of the forceps was assisted via a long sheath in cases involving a complicated bloodstream. Subjects: Among 564 cases of arterio-venous access occlusion that received treatment at this hospital between May 2014 and April 2017, the subjects of this study were 468 cases who could be followed up. Thrombectomy of an organized thrombus using the biopsy forceps was performed 194 times in 138 cases. Biopsy forceps were used in the initial treatment in a total of 115 cases, including 71 cases of acute occlusion of an autologous vein, 3 cases of chronic occlusion of an autologous vein, and 41 cases of acute occlusion of a prosthetic vessel. Results: The initial success rate for all cases of occlusion was 97.2%. The initial success rate for cases in which biopsy forceps were used was 98.2%. For cases using biopsy forceps, the primary patency rates were 47.1% at 3 months, and the secondary patency rates (until occlusion) were 89.1% at 3 months. Conclusion: This method was considered to be a valuable choice as a countermeasure against organized thrombi.

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Section: Discussionmentioning

confidence: 62%

Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion

Wakabayashi¹

2019

J Vasc Access

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“…Concerning the one-year secondary patency rate, the 82.6% and 56.3% rates of one-year secondary patency in the endovascular and open thrombectomy groups in the present study are in some ways different and in some ways comparable to the results reported by Tordoir, et al (23-62% and 27-65%) and Hongsakul, et al (54.3% and 57%). Recent study from Koraen-Smith, et al 12 show the same results that thrombolysis group had better assist primary patency.…”

Section: Discussionmentioning

confidence: 66%

“…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.…”

Section: Resultsmentioning

confidence: 99%

Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft

Puangpunngam

2019

Smj

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The aim of this study was to investigate the procedure success rate, one-year primary patency rate, one-year secondary patency rate, and complications compared between endovascular therapy and open surgical thrombectomy for treatment of thrombosed arteriovenous hemodialysis graft. Methods: This retrospective chart review included patients with thrombosed arteriovenous hemodialysis graft who were treated at the

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“…It remains elusive whether the increased epistaxis was associated with higher blood pressure. It was reported that 4% (4/107) of patients who underwent surgical thrombectomy suffered a post-operative infection and required a repeated procedure and antibiotic therapy (20). Endovascular interventions are associated with embolization (21-23), in particular arterial emboli, which occur in >6% of patients receiving percutaneous declotting (24,25).…”

Section: Discussionmentioning

confidence: 99%

“…Of note, the present study has certain limitations. The size of the thrombi was not measured and the study did not focus on underlying stenosis, while these two parameters may constitute as confounding factors (20). Another limitation of the study was the lack of long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

et al. 2019

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Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times. Age, sex, period of dialysis, time of AVF placement, systolic and diastolic blood pressure and thrombus age were similar between the two groups. The efficacy of urokinase infusion via the two routes in resolving thrombosed AVFs, defined as successful fibrinolysis, and the safety, defined as the number of bleeding events, was compared. The cumulative thrombolysis success rate following three sessions of thrombolytic therapy in the local venous thrombolysis group was higher compared with that in the peripheral venous thrombolysis group (85.7 vs. 68.4%; P=0.04). The local thrombolysis group exhibited less ecchymosis (4.1 vs. 14.0%; P=0.07), epistaxis (2.0 vs. 10.5%; P=0.08) and gingival bleeding (4.1 vs. 19.3%; P=0.02) events compared with the peripheral thrombolysis group. Further analyses demonstrated that systolic [odds ratio (OR)=1.10; 95% confidence interval (CI), 1.03-1.17; P<0.01] and diastolic (OR=1.08; 95% CI, 1.02-1.14; P<0.05) blood pressure were protective factors, whereas thrombus age (OR=0.91; 95% CI, 0.84-0.99; P<0.05) was a risk factor for thrombolysis success among patients who underwent local thrombolytic therapy. Overall, the results suggest that local venous infusion of urokinase is superior to peripheral venous infusion for the treatment of patients with thrombosed fistulas.

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Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion

Abstract: Thrombolysis for thrombosis of native and prosthetic dialysis accesses appears to yield better assisted primary patency compared to surgical thrombectomy. Our results suggest that thrombolysis may be considered the first-choice method for treating the thrombosed dialysis access.

Cited by 14 publications

References 20 publications

Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion

Ultrasound-guided removal of organized thrombi using biopsy forceps in dialysis patients with arterio-venous access occlusion

Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft

Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas

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