Document Detail

Is surgical salvage of arteriovenous grafts feasible after unsuccessful percutaneous mechanical thrombectomy?
MedLine Citation:
PMID:  18226010     Owner:  NLM     Status:  MEDLINE    
Treatment of thrombosed dialysis ateriovenous (AV) grafts in the radiology interventional suite requires percutaneous mechanical thrombectomy, along with angioplasty of the underlying stenotic lesion. We analyzed the anatomic reasons for unsuccessful percutaneous thrombectomy of AV grafts, and assessed the feasibility of surgical salvage. The radiologic reports of all thrombosed AV grafts undergoing unsuccessful percutaneous mechanical thrombectomy during a 5-year period were analyzed for the specific problem precluding restoration of graft patency. We also compared the features of patients with unsuccessful graft thrombectomy to those with successful thrombectomy. Of 77 AV grafts undergoing unsuccessful percutaneous thrombectomy, only six (or 8%) could be revised surgically. Inability to salvage the graft surgically was because of: severe draining vein occlusion or stenosis (30 patients); severe central vein lesion (12); multiple intragraft stenoses (11); large pseudo-aneurysms (six); venous anastomotic occlusion (six); and arterial anastomotic occlusion (four). When compared with 211 patients with successful graft thrombectomy, those with unsuccessful thrombectomy were more likely to have a forearm graft (53% vs. 27%, p < 0.001), and more likely to have a lesion in the draining vein (42% vs. 10%, p < 0.001), the central vein (17% vs. 3%, p < 0.001), or within the graft itself (23% vs. 1%, p < 0.001). An unsuccessful percutaneous graft thrombectomy is more likely in forearm than in upper arm grafts, and more likely if there is a lesion in the draining vein, central vein, or within the graft itself. Surgical salvage of a thrombosed AV graft after an unsuccessful percutaneous intervention is rarely feasible. Most patients have a severe anatomic lesion that cannot be repaired, and require creation of a new vascular access.
Ivan D Maya; Tamorie Smith; Carlton J Young; Michael Allon
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2008-01-23
Journal Detail:
Title:  Seminars in dialysis     Volume:  21     ISSN:  0894-0959     ISO Abbreviation:  Semin Dial     Publication Date:    2008 Mar-Apr
Date Detail:
Created Date:  2008-03-26     Completed Date:  2008-07-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911629     Medline TA:  Semin Dial     Country:  United States    
Other Details:
Languages:  eng     Pagination:  174-7     Citation Subset:  IM    
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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MeSH Terms
Arteriovenous Shunt, Surgical*
Cohort Studies
Feasibility Studies
Graft Survival*
Kidney Diseases / therapy
Middle Aged
Renal Dialysis*
Retrospective Studies
Thrombosis / surgery*
Treatment Failure
Grant Support
1 K24 DK59818-01/DK/NIDDK NIH HHS

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

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