Patency of occluded native arteriovenous fistulas after endovascular therapy using duplex ultrasonography

Abstract

Keywords： arteriovenous fistula, vascular access, endovascular therapy, ultrasonography, peripheral nerve block 〈Abstract〉 ［Objectives］ This study aimed to investigate the feasibility, efficacy, and long term patency rate of endovascular declotting of thrombosed native arteriovenous fistulas under duplex imaging. ［Methods］ In 2019 and 2020, 141 cases of acutely occluded native arteriovenous fistulas were treated with endovascular declotting by one surgeon at Nagoya Vascular Surgery Clinic. Most cases were treated with thromboaspiration via a 4 8 Fr sheath followed by percutaneous transluminal angioplasty (PTA). All procedures were carried out under selective cutaneous nerve blocks, with duplex ultrasonography used as the sole imaging modality. The technical success rate and patency rate were assessed. Assisted primary patency was defined as the period between treatment and any surgical intervention. ［Results］ The technical success rate was 96.5％. The median operation time was 64 minutes. PTA was performed in 121 (85.8％) cases, thrombolysis with urokinase was performed in 15 (11％) cases, and endovascular forceps were used in 29 (20.6％) cases. There were 9 complications, of which two resulted in procedure failure and immediate conversion to open surgery. The median duration of the follow up period was 17.3 months. The primary patency rate was 41.8％ at 6 months and 28.6％ at 1 year. The assisted primary patency rate was 87.0％ at 1 year and 85.6％ at 2 years. ［Conclusions］ Although the primary patency rate was low, the good results regarding the technical success rate and assisted primary patency rate encourage the aggressive application of endovascular treatment for acutely occluded native arteriovenous fistulas.