title: Fistulogram after arteriovenous dialysis graft thrombectomy should be mandatory.
abstract: The purpose of this study was to determine if fistulogram after prosthetic arteriovenous dialysis graft thrombectomy would reveal underlying lesions, which need correction, and if revision would improve graft patency. One hundred and ninety-two open thrombectomy procedures in 61 patients from January 1, 2000 to July 31, 2005 were reviewed retrospectively. All of the study patients were divided into two groups: In Group I fistulogram was carried out and in Group II no fistulogram was performed. Based on the fistulogram or clinical findings, appropriate intervention was carried out. In Group I, of 99 thrombectomy procedures, a significant lesion was identified and revision was carried out in 77 cases (78%). In Group II, of 93 thrombectomy procedures, a significant lesion was identified and revised in 53 cases (57%). A significant abnormality was more likely to be encountered by routine fistulogram than surgical exploration alone, 78 per cent versus 57 per cent (P < 0.05). Assisted primary patency is significantly increased in Group I and II when revision was performed (4.84 months) compared with when no fistulogram and no revision was performed (2.9 months), P < 0.05. Routine fistulogram after thrombectomy of an arteriovenous dialysis graft increases the likelihood of identifying a significant stenosis. Revision of the graft increases the longevity. We recommend routine use of fistulogram during thrombectomy.
authors.affiliation: Kalamazoo Center for Medical Studies, Michigan State University, College of Human Medicine, Kalamazoo, Michigan, USA. kumarsh2@msu.edu
authors.forename: Shakthi D
authors.initials: SD
authors.lastname: Kumar
authors.forename: Krishna M
authors.initials: KM
authors.lastname: Jain
authors.forename: Shikha
authors.initials: S
authors.lastname: Jain
authors.forename: John S
authors.initials: JS
authors.lastname: Munn
authors.forename: Mark C
authors.initials: MC
authors.lastname: Rummel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D016009:Chi-Square Distribution; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D015641:Radiography, Interventional; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene