Maintenance of functional arteriovenous dialysis grafts (AVG) is difficult secondary to low primary patency, need for re-interventions, and limited alternative dialysis access options. We assessed our experience with percutaneous thrombectomy for treating occluded AVGs.
We performed a retrospective analysis of all percutaneous thrombectomies for AVGs from 2015 and 2017. These were generally performed using mechanical thrombectomy and occasional chemical tissue plasminogen activator thrombolysis, over the wire balloon embolectomy for inflow, and adjunctive inflow and outflow interventions as necessary. Perioperative outcomes, long-term patency, re-interventions, and need for new permanent access placement were analyzed.
There were 218 percutaneous thrombectomies performed on 86 AVGs in 77 patients. Approximately half (53.2%) of the patients were male and 68.8% were black. Mean age was 61.1±13.0 years. At the time of thrombectomy, 73.8% underwent venous outflow interventions and 4.5% underwent arterial inflow interventions. Within 30 days, 24.8% of declotted grafts underwent repeat percutaneous thrombectomy, 14.3% required tunneled dialysis catheter placement, 4% developed minor access site/graft infections, and one patient underwent surgical arterial thrombectomy for arm ischemia. There were no venous thromboembolic (VTE), cardiopulmonary, cerebrovascular complications, or clinically significant pulmonary embolism. At 1 and 3 years after percutaneous thrombectomy, freedom from repeat thrombosis was 48% and 25.5%, respectively, and freedom from new dialysis access placement was 66% and 51%, respectively. Overall patient survival was 82% at 3 years.
Percutaneous thrombectomy of AVGs is safe and is associated with acceptable patency rates. This minimally invasive method extends AVG use for these high-risk patients with limited dialysis access options.

Copyright © 2020. Published by Elsevier Inc.

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