Predictors of early dialysis vascular-access failure after thrombolysis.
BACKGROUND
Vascular-access patency is critical for effective and uninterrupted haemodialysis. Limited literature exists evaluating if a surgical or repeated radiological approach is superior for reocclusion following failure of radiological recanalization. Few consistent early predictors of failure have been identified after radiological intervention for thrombosed vascular access.


METHODS
138 patients with thrombosed arteriovenous fistulas or prosthetic grafts treated by radiological intervention, over 10 years, were retrospectively investigated. Reocclusion was treated by either repeated thrombolysis or surgery. Radiological patency rates, after first and second episodes of access thrombosis at 12 months after intervention were analysed. Surgical and radiological patency rates for second access thrombosis were compared. The Cox and logistic regression models were used to identify potential factors associated with reocclusion.


RESULTS
In patients who experienced reocclusion within 1 month after radiological intervention, the 3-month repeated radiological patency rate (n = 13) was 38.5%, compared to a 60% surgical patency rate (n = 10), but this did not reach statistical significance. Radiological patency rates after first access thrombosis at 3 and 12 months were 56.6 and 39.5%, respectively. In contrast, radiological patency rates after a second access thrombosis were 51.1 and 24.4%, respectively; a statistical difference in success was not achieved. Native arteriovenous fistulas were 3.23 times as likely to remain patent over 12 months following a first radiological intervention (p < 0.02) and less likely to experience a second reocclusion event (p < 0.01). Anticoagulation was associated with a lower risk of second reocclusion, whilst a history of venous thrombosis was associated with a greater risk (p < 0.02).


CONCLUSIONS
Surgery achieves superior patency rates compared to repeated radiological interventions and should be considered if reocclusion occurs within a month following radiological thrombolysis.
Crikis
Sandra
S
Department of Nephrology, Austin Health, Melbourne, Australia.
Lee
Darren
D
Brooks
Mark
M
Power
David A
DA
Ierino
Francesco L
FL
Levidiotis
Vicki
V
D001164:Arteriovenous Fistula; D001166:Arteriovenous Shunt, Surgical; D015331:Cohort Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000532:radiotherapy / Q000628:therapy; D015233:Models, Statistical; D009398:Nephrology / Q000379:methods*; D016016:Proportional Hazards Models; D015642:Radiology, Interventional / Q000379:methods*; D012044:Regression Analysis; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency