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Objective: This study aimed to report the outcomes of endovascular salvage of clotted arteriovenous (AV) accesses and to determine potential predictors of poor patency rates after thrombectomy.
Methods: Records of hemodialysis patients who underwent endovascular salvage of clotted AV access were reviewed retrospectively. Technical and clinical success rates, complication rates, and 3- and 6-month patency rates were determined. Multivariate analysis was performed to determine the predictors of patency after thrombectomy.
Results: A total of 294 patients underwent endovascular salvage of clotted AV access during the study period; 156 patients had arteriovenous fistula, whereas the remaining 138 were arteriovenous grafts (AVGs). The technical and clinical success rates were 96.3% and 93.2%; the major and minor complication rates were 0.7% and 9.9%. Post-thrombectomy primary, assisted primary, and secondary patency rates were 62.9%, 76.2%, and 77.6% at 3 months and 43.9%, 59.5%, and 61.6% at 6 months. The patency rates were significantly better for arteriovenous fistula than for AVG except for 6-month assisted primary and secondary patency. Multivariate Cox regression analysis showed that prior thrombosis within 90 days was significantly associated with loss of primary patency (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.21-2.98; P < .01), assisted primary patency (HR, 2.42; 95% CI, 1.42-4.13; P < .01), and secondary patency (HR, 2.52; 95% CI, 1.40-4.53; P < .01). Having an AVG was also negatively associated with primary patency.
Conclusions: Most clotted AV accesses can be salvaged by endovascular technique. Recurrent thrombosis within 90 days is associated with poor short- and long-term patency even after successful endovascular reinterventions.
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http://dx.doi.org/10.1016/j.jvs.2019.07.056 | DOI Listing |
Front Surg
December 2024
Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Background: Chronic limb-threatening ischemia (CLTI) is the most severe form of peripheral artery disease (PAD). Patients with diabetes mellitus (DM) have a faster progression of PAD and a fourfold increased risk of CLTI compared to patients without DM. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculation, relieve ischemic pain and reduce the number of amputations in patients with PAD.
View Article and Find Full Text PDFKhirurgiia (Mosk)
December 2024
Petrozavodsk State University, Petrozavodsk, Russia.
Objective: To evaluate the mid-term results of endovascular revascularization of the lower extremities through primary retrograde distal approach.
Material And Methods: We prospectively analyzed the mid-term results of 74 endovascular surgeries via primary retrograde distal approach in 69 patients with lower extremity ischemia. Mean age of patients was 68.
J Vasc Surg Cases Innov Tech
February 2025
Department of Vascular Surgery, Western University, London, Ontario, Canada.
This case report describes the endovascular management of a hybrid arch dissection stent inadvertently deployed in the false lumen during acute type A aortic dissection repair, resulting in renal and lower extremity malperfusion. Prompt identification and intervention are essential to minimize the morbidity and mortality associated with malperfusion. Various endovascular strategies exist to restore perfusion, and this case highlights a unique approach given the obliteration of the true lumen proximally and anatomy of the visceral ostia predominantly originating from the false lumen.
View Article and Find Full Text PDFSemin Vasc Surg
December 2024
Division of Vascular Surgery and Endovascular Therapy, University of Vermont Medical Center, 111 Colchester Avenue, Smith 338, Burlington, VT 05401. Electronic address:
End-stage renal disease is an independent risk factor for the development of peripheral arterial disease, with considerably worse outcomes in patients with concomitant diseases. It is important to realize the widespread, yet frequently asymptomatic, nature of peripheral arterial disease in patients with end-stage renal disease due to the presence of other comorbidities that decrease activity levels and sensation to allow for early recognition and timely medical management to try and mitigate otherwise poor outcomes. Despite their high risk, properly selected patients derive benefit from revascularization; both open and endovascular approaches provide similar outcomes in terms of overall survival, amputation-free survival, and limb salvage, with perhaps a slight preference toward open repair.
View Article and Find Full Text PDFAnn Vasc Surg
December 2024
Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA.
Objectives: Chronic Limb Threatening Ischemia (CLTI) is associated with high morbidity and mortality. As such, close follow-up is recommended to ensure patency of revascularization, limb viability, and optimization of cardiovascular risk factors. This study aimed to test the association between follow-up adherence and mortality, and to identify risk factors for non-adherence with recommended vascular follow-up.
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