Document Detail


Non-surgical salvage of thrombosed arterio-venous fistulae: a case series and review of the literature.
MedLine Citation:
PMID:  17897255     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Attempts to salvage thrombosed hemodialysis arterio-venous fistulae (AVF) using interventional techniques are not universally performed. Patients often require temporary dialysis catheters pending creation of a new vascular access. We determined the long-term outcome of interventional (non-surgical) repair of completely thrombosed AVF in 49 consecutive accesses (22 radio-cephalic, 1 radio-basilic, 19 brachio-cephalic, and 7 brachio-basilic) referred for an intervention within 48 hours of thrombosis. Subjects were 65% male (32), with mean +/- SD age 63.7 +/- 13.5 years (range 33-91), 51% African-American (25), 47% Caucasian (23) and 65% had diabetes (32). Overall, 96% (47/49) of thrombosed AVF were salvaged with complications observed in four cases (two extravasations of contrast; two radial artery emboli), with no serious long-term sequelae. Interventional procedures included 34 venous angioplasties, 11 venous angioplasties with stenting and two combined venous and arterial angioplasties. The primary and secondary patency rates for all salvaged AVF were 50.5 +/- 8.7%, 72.5 +/- 7.8% at 1 year, and 43.3 +/- 10%, 55.4 +/- 12.7% at 2 years, respectively. The median estimate to first intervention after the declot procedure was 14.7 months. The median estimate for continued function exceeded 23.1 months. There was no significant statistical difference in the primary (p = 0.73) and secondary patency rates (p = 0.057) for forearm vs. upper arm AVF. We conclude that interventional repairs should routinely be employed to salvage newly thrombosed AVF. The vast majority of these individuals can avoid receiving dialysis catheters or placement of a new dialysis vascular access.
Authors:
Shahriar Moossavi; John D Regan; Eric D Pierson; John M Kasey; Audrey B Tuttle; Tushar J Vachharajani; Michael A Bettmann; Gregory B Russell; Barry I Freedman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Seminars in dialysis     Volume:  20     ISSN:  0894-0959     ISO Abbreviation:  Semin Dial     Publication Date:    2007 Sep-Oct
Date Detail:
Created Date:  2007-09-27     Completed Date:  2007-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  459-64     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Wake Forsest University School of Medicine, Winston-Salem, North Carolina 27157-1053, USA. smoossav@wfbmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angiography
Arteriovenous Shunt, Surgical*
Brachiocephalic Veins / surgery
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic / therapy
Male
Middle Aged
Radial Artery / surgery
Renal Dialysis / methods
Retrospective Studies
Salvage Therapy / methods*
Thrombosis / radiography,  therapy*
Time Factors
Treatment Outcome

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


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