Pharmacomechanical Thrombolysis for the Treatment of Thrombosed Native Arteriovenous Fistula: A Single-Center Experience

Boonsrirat, Ussanee; Hongsakul, Keerati

doi:10.12659/pjr.890801

Cited by 11 publications

(7 citation statements)

References 19 publications

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“…Moreover, significant stenosis of the central vein is a cause of dialysis shunt dysfunction, dilated superficial collateral veins, and cellulitis ( 1 ). In addition, dialysis shunt thrombosis ( 2 3 ) or prolonged hemostasis is a further complication arising from shunt dysfunction ( 1 ).…”

Section: Introductionmentioning

confidence: 99%

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

et al. 2018

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ObjectiveTo report the results of angioplasty with paclitaxel-coated balloons for the treatment of early restenosis of central veins in hemodialysis patients.Materials and MethodsSixteen patients (9 men and 7 women; mean age 65.8 ± 14.4 years; range, 40–82 years) with 16 episodes of early restenoses of central veins within 3 months (median patency duration 2.5 months) were enrolled from January 2014 to June 2015. Ten native central veins and 6 intra-stent central veins were treated with double paclitaxel-coated balloons (diameter 6–7 mm) plus a high pressure balloon (diameter 12–14 mm). The study outcomes included procedural success (< 30% residual stenosis) and primary patency of the treated lesion (< 50% angiographic stenosis without re-intervention).Results Procedural success was achieved in all 16 cases of central vein stenoses. The mean diameter of the central vein was 3.7 ± 2.4 mm before the procedure vs. 11.4 ± 1.8 mm after the initial procedure. There were no procedure-related complications. The mean diameters of the central veins at 6 months and 12 months were 7.8 ± 1.3 mm and 6.9 ± 2.7 mm, respectively. The primary patency rates at 6 months and 12 months were 93.8% and 31.2%, respectively. One patient had significant restenosis of the central vein at 3 months. The median primary patency period was 9 months for paclitaxel-coated balloons and 2.5 months for the last previous procedure with conventional balloons (p < 0.001).ConclusionIn our limited study, paclitaxel-coated balloons seem to improve the patency rate in cases of early restenosis of central veins. However, a further randomized control trial is necessary.

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Section: Introductionmentioning

confidence: 99%

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

et al. 2018

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“… 16 ) Contraindications for CDT include allergy to rTPA, bleeding diathesis, recent gastrointestinal bleeding, significant cerebrovascular accident including haemorrhage or large infarction within the previous 6 months or surgery within the previous 3 months. 18 ) In addition to the factors listed, our centre uses a cut-off age of 80 years to decide whether patients are candidates for CDT.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?

Yeo

Yong

Hong

et al. 2021

Annals of Vascular Diseases

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Objective : To review the outcomes of catheter-directed thrombolysis (CDT) for salvage of thrombosed arteriovenous fistula (AVF) in a single centre in Southeast Asia. Methods : A retrospective study of CDT in AVF between January 2015 and July 2018 at a tertiary university hospital was carried out. Results : Within the study period, 85 patients underwent CDT for AVF thrombosis. Of these patients, 78% underwent CDT for 24 h and 12% required CDT for 48 h. Moreover, 14% of patients had bleeding during CDT and hence required a decrease in dosing or complete cessation. Incidence of intracranial haemorrhage was 1%, and technical success was 92%. Post CDT, primary patency rates at 12, 24 and 36 months were 87%, 62% and 36%, respectively; assisted primary patency rates at 12, 24 and 36 months were 96%, 82% and 69%, respectively; and secondary patency rates at 12, 24 and 36 months were 99%, 93% and 86%, respectively. Multivariate analysis did not identify any predictive factors for patency post CDT. Conclusion : Within our study population, CDT for AVF salvage conferred good technical results with low rates of complications. There was good primary patency at 12 months, and the results were sustained up to 36 months. It remains a useful modality for fistula salvage, avoiding surgical intervention.

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“…Most patients with AVF thrombosis also have stenosis of the fistula. Therefore, the simple removal of thrombus without treatment of stenosis will likely lead to short-term treatment failure [12,25]. The use of an arterial thrombectomy device provides rapid recovery of blood flow through the fistula, and requires a low dose of a thrombolytic agent, leading to fewer thrombolysis-related complications.…”

Section: Discussionmentioning

confidence: 99%

“…Following the development of interventional radiology, percutaneous methods are now more commonly used to restore AVF patency [9–11]. Pharmacological and/or mechanical thrombolysis can dissolve or remove the thrombus in the failed AVF [12,13] but do not address the AVF stenosis. Angioplasty alone can adequately restore the patency of a stenosed AVF [14], but the fistula thrombus must be treated first.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Thrombolysis with Percutaneous Transluminal Angioplasty Using a Trans-Brachial Approach to Treat Thrombosed Arteriovenous Fistulas

Wang

et al. 2019

Med Sci Monit

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Background Arteriovenous fistulas (AVFs) are used to provide vascular access for hemodialysis in patients with end-stage renal failure. However, stenosis and thrombosis can compromise long-term AVF patency. The objective of this study was to evaluate catheter thrombolysis with percutaneous transluminal angioplasty (PTA), using a trans-brachial approach, for acutely thrombosed AVFs. Material/Methods This retrospective study examined 30 cases of AVF thrombosis treated between January 1, 2015 and January 1, 2017. All patients received transcatheter thrombolysis with PTA using a trans-brachial approach. AVF patency was assessed after 6 months. Results Thrombolysis with PTA was performed at 2 to 72 h after diagnosis of AVF occlusion due to acute thrombosis, and AVF patency was restored in all patients. After 6 months, the primary and secondary patency rates were 76.7% and 93.3%, respectively. For type I stenosis, primary patency was achieved in 10 of 16 patients (62.5%) and secondary patency was achieved in 14 of 16 patients (87.5%). For type II stenosis, primary patency was achieved in 13 of 14 patients (92.9%) and secondary patency was achieved in 14 of 14 patients (100%). Comparing type I and II stenosis, a significant difference was detected in the rates of primary patency (odds ratio=0.909, 95% confidence interval 0.754–1.096, P=0.049), but not secondary patency (P=0.178), after 6 months. Conclusions Our study provides preliminary evidence that catheter-directed thrombolysis with PTA using a trans-brachial approach can achieve high patency rates when used to treat acutely thrombosed AVFs.

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Pharmacomechanical Thrombolysis for the Treatment of Thrombosed Native Arteriovenous Fistula: A Single-Center Experience

Cited by 11 publications

References 19 publications

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

Paclitaxel-Coated Balloon Angioplasty for Early Restenosis of Central Veins in Hemodialysis Patients: A Single Center Initial Experience

Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?

Transcatheter Thrombolysis with Percutaneous Transluminal Angioplasty Using a Trans-Brachial Approach to Treat Thrombosed Arteriovenous Fistulas

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