Timely thrombectomy can improve patency of hemodialysis arteriovenous fistulas
Journal
Journal of Vascular Surgery
Journal Volume
67
Journal Issue
4
Pages
1217-1226
Date Issued
2018
Author(s)
Chen D.-M.
Lee M.-H.
Shen Y.-F.
Chuang S.-Y.
Abstract
Objective: The urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis. Methods: A before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution. Data about thrombectomy procedures, performed within 1 year before and after the initiative was introduced, were abstracted from an electronic database. Immediate outcomes and patency outcomes were compared between the preinitiative (control) and postinitiative (intervention) groups. Results: During the study period, 329 patients were enrolled, including 165 cases before and 164 cases after the initiative. The intervention group had more thrombectomy procedures performed within 24 hours (93% vs 55%; P <.01) and within 48 hours (97% vs 79%; P <.01) than the control group. No between-group differences in procedural success or clinical success rates were found. At 3 months, the intervention group had a higher postintervention primary patency rate than the control group, although this did not reach statistical significance (58% vs 48%; P =.06). After stratification into native or graft accesses, the patency benefit was observed in the native access group (68% vs 50%; P =.03) but not in the graft access group (50% vs 46%; P =.65). After adjusting for potential confounders, timely thrombectomy remained an independent predictor of postintervention primary patency (hazard ratio, 0.449; 95% confidence interval, 0.224-0.900; P =.02) for native dialysis accesses. Conclusions: Our results suggest that a timely thrombectomy approach, in which salvage is attempted within 24 hours of thrombosis diagnosis, improves postintervention primary patency of native but not graft accesses for dialysis. ? 2017 Society for Vascular Surgery
SDGs
Other Subjects
acetylsalicylic acid; angiotensin receptor antagonist; antithrombocytic agent; clopidogrel; dipeptidyl carboxypeptidase inhibitor; hydroxymethylglutaryl coenzyme A reductase inhibitor; aged; arterial embolization; arteriovenous fistula; Article; blood vessel rupture; case control study; controlled study; female; graft patency; hemodialysis; human; major clinical study; male; percutaneous thrombectomy; percutaneous transluminal angioplasty; postoperative complication; priority journal; retrospective study; thrombosis; vascular access; arteriovenous shunt; blood vessel transplantation; chi square distribution; comparative study; diagnostic imaging; factual database; graft occlusion; health care quality; Kaplan Meier method; middle aged; multivariate analysis; pathophysiology; procedures; program evaluation; proportional hazards model; risk factor; salvage therapy; standards; thrombectomy; thrombosis; time factor; time to treatment; total quality management; treatment outcome; vascular patency; very elderly; Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical; Blood Vessel Prosthesis Implantation; Chi-Square Distribution; Databases, Factual; Female; Graft Occlusion, Vascular; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Program Evaluation; Proportional Hazards Models; Quality Improvement; Quality Indicators, Health Care; Renal Dialysis; Retrospective Studies; Risk Factors; Salvage Therapy; Thrombectomy; Thrombosis; Time Factors; Time-to-Treatment; Treatment Outcome; Vascular Patency
Publisher
Mosby Inc.
Type
journal article