The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist

Abstract

BackgroundSalvage of a thrombosed arteriovenous fistula (AVF) by secondary fistula conversion may be more effective than a conventional endovascular procedure for forearm fistula thrombosis. Surgical access procedures are an undeveloped area in interventional nephrology compared to endovascular procedures. Herein, the author report the results of surgical salvage of thrombosed AVFs by interventional nephrologists.MethodsThe author retrospectively analyzed 52 surgical salvage procedures for AVF thrombosis (radiocephalic fistula = 44 cases, brachiocephalic fistula = 8 cases) that were performed by interventional nephrologist between March 2007 and January 2016.ResultsSecondary fistula formation using the proximal vein was performed for 46 cases (88.5%); outflow rerouting was performed for two cephalic-arch stenosis cases (3.9%), simple thrombectomy was performed for two cases (3.9%), and a graft interposition was performed for two cases (3.9%). Technical success after the surgical procedures was achieved in 51 cases (98.1%), and 39 AVFs (75.0%) were prepared for immediate puncturing without catheter insertion. The primary and secondary patency rates for AVF at 6, 12, 18, and 24 months were 88.5%, 83.2%, 83.2%, and 83.2% and 96.0%, 96.0%, 93.2%, and 93.2%, respectively. The re-intervention rate was 0.27 ± 0.92/patient/ year.ConclusionBased on these results, the author conclude that surgical salvage of a thrombosed AVF, when performed under local anesthesia by a skilled interventional nephrologist, offers favorable short- and long-term success and should be the preferred treatment.

Imaging Diagnosis and Interventional Treatment for Hepatocellular Carcinoma Combined with Arteriovenous Fistula

“…In the presence of HAPVF, a large amount of high-pressure arterial blood directly enters the portal vein through the fistula, causing the portal vein pressure to rise further, aggravating the formation of upper gastrointestinal bleeding and ascites. At the same time, the presence of HAPVF prevented chemotherapy embolization of cancer and embolization must reach the level of capillaries [ 20 ]. On the one hand, it blocks the hepatic artery-portal vein shunt and relieves gastrointestinal bleeding and ascites caused by portal hypertension and on the other hand facilitates superselective embolization of tumor blood vessels, protects normal hepatic tissue, and reduces distant metastasis.…”

Salvage of thrombosed arteriovenous fistulae of patients on hemodialysis: report on the experience of a Brazilian center

“… 7 , 14 , 15 , 16 , 22 . Several studies cited the performance of the procedures by interventional nephrologists 8 , 14 , 18 , 22 , 23 , 25 , with complication rates similar to other specialists.…”

Where Are You Going, Nephrology? Considerations on Models of Care in an Evolving Discipline

“…International data indicate that the results of nephrology-related treatments (dialysis access, post-transplant care, interventional nephrology, diagnostic procedures, etc.) are at least as good when performed in nephrology as when they are delegated to other specialities [ 55 , 56 , 57 , 58 , 59 , 60 ]. While there is an obvious bias linked to the fact that only the most motivated and best-qualified centres perform these satellite activities, the evidence that is available indicates that this expertise should be maintained and developed when logistically feasible.…”