Endovascular salvage of thrombosed haemodialysis vascular access: 10 year tertiary centre experience

Ganesh Deogaonkar; Narayanan Thulasidasan; Rutuja Phulambrikar; Athanasios Diamantopoulos; Kiran Sran; Irfan Ahmed; Ioannis Loukopoulos; Narayan Karunanithy

doi:10.1024/0301-1526/a001043

Endovascular salvage of thrombosed haemodialysis vascular access: 10 year tertiary centre experience

Ganesh Deogaonkar, Narayanan Thulasidasan, Rutuja Phulambrikar, Athanasios Diamantopoulos, Kiran Sran, Irfan Ahmed, Ioannis Loukopoulos, Narayan Karunanithy^*

^*Corresponding author for this work

Biomedical Engineering & Imaging Sciences

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Background: Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Patients and methods: Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019. Patient demographics, access circuit characteristics, procedure details and outcome data were collected. Kaplan-Meier survival curves were used to estimate patency rates and Cox multivariate regression analysis to identify factors affecting outcomes. Results: Technical and clinical success rates were 87.8% and 75.9% respectively. The primary, primary assisted and secondary patency rates at 6 months were 42.2%, 46.7% and 59.1%; and at 12 months were 23.4%, 28.3% and 41.8% respectively. Median access circuit survival was 9.2 months. Major complication rate was 5.2% including 3 procedure-related deaths. Native AVF, lower time from thrombosis to intervention and pharmacomechanical thrombectomy using AngioJetTM predicted positive outcomes. Previous thrombectomy within 3 months and residual thrombus at completion were associated with poorer outcomes. Age and hypertension predicted higher complication rates. Conclusions: This is one of the largest single center series of endovascular salvage of thrombosed haemodialysis access and demonstrates that endovascular treatment is effective and provides durable access circuit survival. Careful patient screening is essential to optimize outcomes.

Original language	English
Pages (from-to)	63-70
Number of pages	8
Journal	Vasa - European Journal of Vascular Medicine
Volume	52
Issue number	1
DOIs	https://doi.org/10.1024/0301-1526/a001043
Publication status	Published - Jan 2023

Keywords

AVF
AVG
endovascular salvage
Fistula thrombectomy
hemodialysis access

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1024/0301-1526/a001043

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title = "Endovascular salvage of thrombosed haemodialysis vascular access: 10 year tertiary centre experience",

abstract = "Background: Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Patients and methods: Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019. Patient demographics, access circuit characteristics, procedure details and outcome data were collected. Kaplan-Meier survival curves were used to estimate patency rates and Cox multivariate regression analysis to identify factors affecting outcomes. Results: Technical and clinical success rates were 87.8% and 75.9% respectively. The primary, primary assisted and secondary patency rates at 6 months were 42.2%, 46.7% and 59.1%; and at 12 months were 23.4%, 28.3% and 41.8% respectively. Median access circuit survival was 9.2 months. Major complication rate was 5.2% including 3 procedure-related deaths. Native AVF, lower time from thrombosis to intervention and pharmacomechanical thrombectomy using AngioJetTM predicted positive outcomes. Previous thrombectomy within 3 months and residual thrombus at completion were associated with poorer outcomes. Age and hypertension predicted higher complication rates. Conclusions: This is one of the largest single center series of endovascular salvage of thrombosed haemodialysis access and demonstrates that endovascular treatment is effective and provides durable access circuit survival. Careful patient screening is essential to optimize outcomes.",

keywords = "AVF, AVG, endovascular salvage, Fistula thrombectomy, hemodialysis access",

author = "Ganesh Deogaonkar and Narayanan Thulasidasan and Rutuja Phulambrikar and Athanasios Diamantopoulos and Kiran Sran and Irfan Ahmed and Ioannis Loukopoulos and Narayan Karunanithy",

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year = "2023",

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doi = "10.1024/0301-1526/a001043",

language = "English",

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TY - JOUR

T1 - Endovascular salvage of thrombosed haemodialysis vascular access

T2 - 10 year tertiary centre experience

AU - Deogaonkar, Ganesh

AU - Thulasidasan, Narayanan

AU - Phulambrikar, Rutuja

AU - Diamantopoulos, Athanasios

AU - Sran, Kiran

AU - Ahmed, Irfan

AU - Loukopoulos, Ioannis

AU - Karunanithy, Narayan

PY - 2023/1

Y1 - 2023/1

N2 - Background: Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Patients and methods: Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019. Patient demographics, access circuit characteristics, procedure details and outcome data were collected. Kaplan-Meier survival curves were used to estimate patency rates and Cox multivariate regression analysis to identify factors affecting outcomes. Results: Technical and clinical success rates were 87.8% and 75.9% respectively. The primary, primary assisted and secondary patency rates at 6 months were 42.2%, 46.7% and 59.1%; and at 12 months were 23.4%, 28.3% and 41.8% respectively. Median access circuit survival was 9.2 months. Major complication rate was 5.2% including 3 procedure-related deaths. Native AVF, lower time from thrombosis to intervention and pharmacomechanical thrombectomy using AngioJetTM predicted positive outcomes. Previous thrombectomy within 3 months and residual thrombus at completion were associated with poorer outcomes. Age and hypertension predicted higher complication rates. Conclusions: This is one of the largest single center series of endovascular salvage of thrombosed haemodialysis access and demonstrates that endovascular treatment is effective and provides durable access circuit survival. Careful patient screening is essential to optimize outcomes.

AB - Background: Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Patients and methods: Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019. Patient demographics, access circuit characteristics, procedure details and outcome data were collected. Kaplan-Meier survival curves were used to estimate patency rates and Cox multivariate regression analysis to identify factors affecting outcomes. Results: Technical and clinical success rates were 87.8% and 75.9% respectively. The primary, primary assisted and secondary patency rates at 6 months were 42.2%, 46.7% and 59.1%; and at 12 months were 23.4%, 28.3% and 41.8% respectively. Median access circuit survival was 9.2 months. Major complication rate was 5.2% including 3 procedure-related deaths. Native AVF, lower time from thrombosis to intervention and pharmacomechanical thrombectomy using AngioJetTM predicted positive outcomes. Previous thrombectomy within 3 months and residual thrombus at completion were associated with poorer outcomes. Age and hypertension predicted higher complication rates. Conclusions: This is one of the largest single center series of endovascular salvage of thrombosed haemodialysis access and demonstrates that endovascular treatment is effective and provides durable access circuit survival. Careful patient screening is essential to optimize outcomes.

KW - AVF

KW - AVG

KW - endovascular salvage

KW - Fistula thrombectomy

KW - hemodialysis access

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JO - Vasa - European Journal of Vascular Medicine

JF - Vasa - European Journal of Vascular Medicine

IS - 1

ER -

Endovascular salvage of thrombosed haemodialysis vascular access: 10 year tertiary centre experience

Abstract

Keywords

UN SDGs

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