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Comparative Analysis of Surgical Thrombectomy with Revision and Percutaneous Thrombectomy with Angioplasty for Treating Obstruction of a Dialysis Graft  

Lim, Jae-Woong (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University)
Won, Yong-Soon (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University)
Kim, Dong-Hyun (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University)
Shin, Hwa-Kyun (Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, College of Medicine, Soonchunhyang University)
Publication Information
Journal of Chest Surgery / v.42, no.4, 2009 , pp. 487-491 More about this Journal
Abstract
Background: Salvaging prosthetic arteriovenous grafts can be performed using surgical or endovascular techniques. We conducted a retrospective analysis to compare the efficacy of these two methods for restoring dialysis graft function. Material and Method: We studied 41 patients who had received surgical thrombectomy with revision (Group A) or percutaneous thrombectomy with angioplasty (Group B) from January 2006 to December 2007. We compared them according to the patient characteristics and the location of stenotic lesions, and we analyzed the post-intervention primary patency rates. Result: 21 patients underwent surgery and 20 patients underwent percutaneous balloon angioplasty. There were no significant differences of the patients' characteristics between the two groups. Venous anastomotic stenosis was the most common cause of graft thrombosis in both groups. In Group A, 90.5% of the grafts remained functional at 6 months and 38.1% remained functional at 12 months. In Group B, 55.0% of the grafts were functional at 6 months and 20.0% of the grafts were functional at 12 months. The post-intervention primary patency rate was significantly better in Group A (p=0.034). Conclusion: Surgical treatment resulted in significantly longer post-intervention primary patency in this study, and this supports its use as the primary method of management for most patients in whom dialysis graft obstruction develops.
Keywords
Arteriovenous fistula; Intervention; Graft occlusion, vascular;
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1 Lumsden AB. Management of thrombosed dialysis access. In: Rutherford RB. Vascular surgery. 6th ed. Philadelphia: WB Saunders Company. 2005;1685
2 Schwartz C, McBrayer C, Sloan J, et al. Thrombosed dialysis grafts: comparision of treatment with transluminal angioplasty and surgical revision. Radiology 1995;194:337-341   DOI   PUBMED
3 Wu CC, Lin MC, Pu SY, Tsai KC, Wen SC. Comparison of cutting balloon versus high-pressure balloon angioplasty for resistant venous stenoses of native hemodialysis fistulas. J Vasc Interv Radiol 2008;19:877-883   DOI   ScienceOn
4 Beathard GA. Thrombolysis versus surgery for the treatment of thrombosed dialysis access grafts. J Am Soc Nephrol 1995;6:1619-1624
5 Trerotola SO, Stavropoulos SW, Shlansky-Goldberg R, et al. Hemodialysis-related venous stenosis: treatment with ultrahigh- pressure angioplasty balloons. Radiology 2004;231:259-262   DOI   ScienceOn
6 Singer-Jordan J, Papura S. Cutting balloon angioplasty for primary treatment of hemodialysis fistula venous stenoses: preliminary results. J Vasc Interv Radiol 2005;16:25-29   DOI   ScienceOn
7 U.S. Renal Data System: X. The cost effectiveness of alternative types of vascular access and the economic cost of ESRD. Am J Kidney Dis 1995;26:140-156   DOI   ScienceOn
8 Green L, Lee D, Kucey D. A metaanalysis comparing surgical thrombectomy, mechanical thrombectomy, and pharmacomechanical thrombolysis for thrombosed dialysis grafts. J Vasc Surg 2002;36:939-945   DOI   ScienceOn
9 Roy-Chaudhury P, Kelly BS, Miller MA, et al. Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts. Kidney Int 2001;59:2325-2334   DOI   PUBMED
10 Swedberg SH, Brown BG, Sigley R, Wight TN, Gordon D, Nicholls SC. Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment. Circulation 1989;80:1726-1736   DOI   PUBMED
11 Turmel-Rodirigues L, Pengloan J, Blanchier D, et al. Insufficient dialysis shunts: Improved long-term patency rates with close hemodynamic monitoring, repeated percutaneous balloon angioplasty, and stent placement. Radiology 1993; 187:273-278
12 Vascular Access 2006 Work Group. Clinical Practice Guidelines for Vascular Acess. Am J Kidney Dis 2006;48:S176- S247   DOI   ScienceOn
13 ESRD Registry Committee. Korean Society of Nephrology Current Renal Replacement Therapy in Korea - Insan Memorial Dialysis Registry 2006 -. J Korean Soc Nephrol 2007;27:459-481
14 Marston W, Criado E, Jaques P, et al. Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis access grafts. J Vasc Surg 1997;26:373-381   DOI   ScienceOn
15 Dougherty MJ, Calligaro KD, Schindler N, Raviola CA, Ntoso A. Endovascular versus surgical treatment for thrombosed hemodialysis grafts: a prospective, randomized study. J Vasc Surg 1999;30:1016-1023   DOI   ScienceOn
16 Schwab SJ, Harrington JT, Singh A, et al. Vascular access for hemodialysis. Kidney Int 1999;55:2078-2090   DOI   PUBMED   ScienceOn
17 Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002;35:603-610   DOI   ScienceOn