Initial experience during balloon angioplasty assisted surgical thrombectomy for thrombosed hemodialysis grafts.
BACKGROUND
Access failure in hemodialysis patients is commonly encountered by vascular surgeons. Researchers have reported various solutions for dealing with clotted grafts, including thrombectomy, thrombolysis, interposition grafting, angioplasty, or a combination of these methods. Surgical thrombectomy has been the standard procedure for dealing with thrombosed hemodialysis grafts in the cardiovascular department of Chang Gung Memorial Hospital. However, to correct associated stenotic lesions and improve the results of surgery, intraoperative balloon angioplasty has been applied in consecutive cases of dialysis graft failure since July 2001.


METHODS
Initial experience with 13 consecutive intraoperative balloon angioplasties performed during a 2-month period was reviewed. Noncompliant high-pressure balloons were used for the procedures. Age, gender, graft age, and initial outcome were reviewed and analyzed.


RESULTS
A success rate of 100% was achieved in the group that underwent thrombectomy plus intraoperative balloon angioplasty. Furthermore, the primary potency rates were 77% at 1 month, 62% at 3 months, and 38% at 6 months.


CONCLUSIONS
We recommend intraoperative balloon angioplasty plus surgical thrombectomy as an effective method of salvaging thrombosed hemodialysis grafts. However, since these are the initial results for this kind of hybrid procedure from a single hospital, large-scale studies with long-term follow up are required.
Ko
Po-Jen
PJ
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC. pjko@cgmh.org.tw
Liu
Yun-Hen
YH
Hsieh
Hung-Chang
HC
Chu
Jaw-Ji
JJ
Lin
Pyng Jing
PJ
D000800:Angioplasty, Balloon / Q000379:methods*; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000601:surgery*