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

Abstract

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.

Analysis of the Effectiveness of Transradial Access Puncture in the Application of Complications and Comfort after Cerebral Angiography

“…Multiple punctures can cause a loss of operator confidence and also lead to radial artery spasms [ 23 , 24 ]. The highest failure rate of transradial artery surgery in small elderly women has been reported in the literature, which may be related to the small size of the radial artery and its susceptibility to spasms [ 25 , 26 ]. Therefore, it is proposed that small elderly women are a relative contraindication to transradial artery surgery.…”

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

“…Technical success rates grossly range from 88% to 98% in the literature, whereas post-CDT primary patency rates at 12 and 24 months range from 42% to 68% and 52% to 67%, respectively, and post-CDT secondary patency rates at 12 and 24 months range from 68% to 72%. [8][9][10][11][12] This therefore highlights the finding that the results for CDT for AVF salvage can be extended to a Southeast Asian population.…”

“…7) Although there is significant literature available on catheter-directed thrombolysis (CDT) and its effectiveness in the salvage of thrombosed AVFs, there are limited studies that involve Southeast Asian populations. [7][8][9][10] Hence, this study aims to review the outcomes of CDT in AVF salvage within a single centre in Southeast Asia, to verify its effectiveness in treatment and viability as an alternative to traditional surgical methods.…”

Recanalization of thrombosed aneurysmal hemodialysis arterovenous fistulas using a hybrid technique based on data from a single center

“…Surgical procedures can also reduce the number of canulation sites and increase the usage of dialysis catheters during the perioperative period. Endovascular procedures are increasingly being used to recanalization a thrombosed AV access [ 8 , 9 ]. However, recanalization becomes difficult when an AVF is obstructed by oversized thrombi inside an aneurysm because of the expanded vascular space and old mural thrombus that may result in symptomatic pulmonary embolism.…”