Thrombosed dialysis access grafts: randomized comparison of the Amplatz thrombectomy device and surgical thromboembolectomy

Abstract

We report the final results of the trial comparing the Amplatz thrombectomy device (ATD) with surgical thromboembolectomy (ST) to declot thrombosed dialysis access grafts (DAG). The study population consisted of 174 DAG, 109 of which were randomized to mechanical thrombectomy using the ATD and 65 of which were randomized to conventional surgical thromboembolectomy. Forty grafts were re-enrolled in the trial when they failed beyond the 90 days follow-up after the initial treatment. Thirty-one were re-enrolled for mechanical thrombectomy and nine were re-enrolled for surgical thrombectomy, resulting in a total of 140 ATD procedures and 74 surgical thromboembolectomy. Immediate thrombectomy success was defined as greater than 90% thrombus removal followed by the ability to dialyze after treatment, and analysis of long term success based on graft patency at 30 and 90 days, with successful dialysis. Immediate thrombectomy success with the ATD procedure was achieved in 79.2% and with ST in 73.4%. Patency of the graft, with successful dialysis, at 30 days with the ATD procedure was 79.2% and with ST was 73.4%. Patency of the graft, with successful dialysis, at 90 days with the ATD procedure was 75.2% and with ST was 67.8%. The data collected in this study provided a prospective comparison of mechanical thrombectomy with the ATD and ST performance in thrombosed DAG. The results of the performance of both methods were comparable. No statistically significant differences were seen.

Efficacy of a Modified Pharmacomechanical Thrombolysis Technique for Endovascular Treatment of Thrombosed Prosthetic Arteriovenous Grafts

“…Our study outcomes demonstrated the effectiveness of the technique, with 95% and 95% technical and clinical success rates, respectively. These results are comparable with previous reports using mechanical thrombectomy devices, which reported rates between 80% and 98% (19, 23-27). Moreover, our modified PMT technique results have acceptable post-interventional primary patency and secondary patencies, with low complication rates.…”

Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)

“…A randomised study did not show any significant difference between surgical thrombectomy and endovascular treatment. 554 Additionally in a metaanalysis including six randomised trials surgical and endovascular therapy in AVGs were compared. It was concluded that endovascular therapy had similar results in terms of primary and primary assisted patency at 1 year compared with surgical thrombectomy.…”

Arteriovenous graft for hemodialysis, graft venous anastomosis closure - current state of knowledge. Minireview

“…The results of the performance of both methods were comparable. No statistically significant differences were found 33 . It is clear that to correct an underlying outlet stenosis after thrombectomy AVG is important.…”