Outcome after early thrombotic occlusion of arteriovenous fistulas

Abstract

Objective: Arteriovenous fistulas (AVFs) are considered the first choice for venous access in end-stage renal disease patients, however, they are also known to have a high primary failure rate (early thrombosis and maturation failure). Of these, the outcome of thrombosed immature AVFs is not well known. This study aimed to investigate the outcome of AVFs with early thrombosis. Methods: Patients who underwent AVF creation from January 2009 to December 2019 at Seoul National University Hospital or Seoul Metropolitan Government – Seoul National University Boramae Medical Center were retrospectively reviewed. Patients who received salvage operations due to early thrombosis within 30 days after access creation were analyzed. Results: During the study period, a total of 45 patients (radiocephalic 26; brachiocephalic 19) developed early thrombosis and underwent salvage operations. The median age of patients was 61.0 (54.5–69.5) years, and 51.1% were male. The first salvage operation was performed on the median 1.0 (0.0–4.5) day after AVF creation. The most common cause for early thrombosis was venous stenosis (64.4%) and followed by poor arterial inflow (28.9%), especially in radiocephalic AVFs. About 20 AVFs were salvaged to maturation (46.5%). Post-salvage primary patency and secondary patency at 1 year was 72.6% and 100%. In a multivariate logistic regression, significant risk factors for maturation failures were minimum venous outflow diameter ⩽2.5 mm (OR, 4.433; 95% CI, 1.039–18.921; p = 0.044) and lower in patients with hypertension (OR, 0.064; 95% CI, 0.006–0.637; p = 0.019). Conclusions: Thrombosed immature AVFs are associated with a high failure rate after salvage operation. However, if the salvage operation is successfully performed, it is associated with an acceptable 1-year outcome.

Treatment of Immediate Arteriovenous Dialysis Graft Failure Using Ultrasound Guided-Percutaneous Transluminal Angioplasty: A Case Report

“…However, early thrombosis is often unsalvageable, leading to the need for creation of a new access. Correspondingly, a study reported that early occlusion (within 30 days of stula creation) was able to undergo salvage surgery, but still had a low probability of maturation 19 . Surgical sutures are removed in the operative area of vascular access construction in the upper extremity after two weeks when the wound has healed.…”