Endovascular thrombectomy versus open surgical thrombectomy for thrombosed arteriovenous hemodialysis graft

Abstract

© 2019, Faculty of Medicine Siriraj Hospital, Mahidol University. Objective: The aim of this study was to investigate the procedure success rate, one-year primary patency rate, one-year secondary patency rate, and complications compared between endovascular therapy and open surgical thrombectomy for treatment of thrombosed arteriovenous hemodialysis graft. Methods: This retrospective chart review included patients with thrombosed arteriovenous hemodialysis graft who were treated at the Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during January 2012 to December 2016. Demographic, graft type, time before treatment, thrombus removal technique, additional technique, procedure success rate, operative, primary and secondary patency, follow-up time, and complication data were collected. Results: Seventy-four thrombosed dialysis grafts were included. Twenty-five and 49 grafts underwent endovascular therapy and open surgical thrombectomy, respectively. There was no significant difference in demographic data, graft type, or adjunct procedure between groups. The procedure success rate was 92% and 98% in the endovascular group and thrombectomy group, respectively (p=0.262). The one-year primary patency rate was 26% in the endovascular group, and 33% in the thrombectomy group (p=0.054). One-year secondary patency rate was 82.6% in the endovascular group, and 56.3% in the thrombectomy group (p=0.122). Conclusion: No significant differences were observed between groups for procedure success rate or 1-year primary patency rate; however, the one-year secondary patency rate in the endovascular group was significantly better than in the thrombectomy group. No difference in complications was observed between groups.