Document Detail

Comparison of clinical effectiveness between surgical and endovascular treatment for thrombotic obstruction in hemodialysis access.
MedLine Citation:
PMID:  21058255     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Endovascular treatment (ET) is widely used for thrombotic complications of vascular access (VA) for hemodialysis. We evaluated the effectiveness of both ET and surgical interventions for thrombotic complications.
METHODS: We studied 533 patients who underwent surgical procedures (a total of 879 procedures) and 54 patients who received ET (a total of 156 procedures) for VA obstruction (endovascular group; group 1). The 533 patients who underwent surgical procedures were further divided into two groups: the surgical balloon-angioplasty group (the thrombus was surgically removed and the stenotic lesions were dilated by balloon angioplasty; 189 procedures; group 2) and the surgical repair group (the stenotic lesions were bypassed with additional graft diversion or creation of a new access; 690 procedures; group 3). The three groups were evaluated for VA patency.
RESULTS: Using the Kaplan-Meier method, the 2-yr patency for groups 1, 2, and 3 were 11.1%, 11.5%, and 34.0% (p<0.0001). The 2-yr patency rates in patients in whom arteriovenous grafts were used were 5.9% (group 1), 9.2% (group 2), and 22.8% (group 3) (p<0.0001), whereas in patients with arteriovenous fistulae they were 33.7% (group 1), 35.7% (group 2), and 59.8% (group 3) (p=0.0005).
CONCLUSIONS: A surgical approach may cause difficulty in creating a new VA, because useful access vessels are limited. Our results indicate surgical balloon-angioplasty and ET provide the same patency. ET is less invasive and can be repeated, which makes it beneficial for the patients. We concluded ET could be considered as the first-line treatment for thrombotic complications.
Yutaka Ito; Takashi Sato; Rei Okada; Nobumasa Nakamura; Keiko Kimura; Ryo Takahashi; Naofumi Miwa; Hiroshi Sakurai; Masato Tsuboi; Hirotake Kasuga
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The journal of vascular access     Volume:  12     ISSN:  1724-6032     ISO Abbreviation:  J Vasc Access     Publication Date:    2011 Jan-Mar
Date Detail:
Created Date:  2011-03-01     Completed Date:  2011-06-28     Revised Date:  2013-03-04    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  63-6     Citation Subset:  IM    
Department of Internal Medicine, Nagoya Kyoritsu Hospital, Nagoya, Japan.
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MeSH Terms
Angioplasty, Balloon
Arteriovenous Shunt, Surgical / adverse effects*
Chi-Square Distribution
Constriction, Pathologic
Endovascular Procedures* / adverse effects
Graft Occlusion, Vascular / etiology,  physiopathology,  surgery,  therapy*
Kaplan-Meier Estimate
Patient Selection
Renal Dialysis*
Retrospective Studies
Risk Assessment
Risk Factors
Thrombectomy* / adverse effects
Thrombosis / etiology,  surgery,  therapy*
Time Factors
Treatment Outcome
Vascular Patency
Comment In:
J Vasc Access. 2012 Oct-Dec;13(4):536; author reply 537   [PMID:  22653830 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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