Comparison of clinical effectiveness between surgical and endovascular treatment for thrombotic obstruction in hemodialysis access.
OBJECTIVE
Endovascular treatment (ET) is widely used for thrombotic complications of vascular access (VA) for hemodialysis. We evaluated the effectiveness of both ET and surgical interventions for thrombotic complications.


METHODS
We studied 533 patients who underwent surgical procedures (a total of 879 procedures) and 54 patients who received ET (a total of 156 procedures) for VA obstruction (endovascular group; group 1). The 533 patients who underwent surgical procedures were further divided into two groups: the surgical balloon-angioplasty group (the thrombus was surgically removed and the stenotic lesions were dilated by balloon angioplasty; 189 procedures; group 2) and the surgical repair group (the stenotic lesions were bypassed with additional graft diversion or creation of a new access; 690 procedures; group 3). The three groups were evaluated for VA patency.


RESULTS
Using the Kaplan-Meier method, the 2-yr patency for groups 1, 2, and 3 were 11.1%, 11.5%, and 34.0% (p<0.0001). The 2-yr patency rates in patients in whom arteriovenous grafts were used were 5.9% (group 1), 9.2% (group 2), and 22.8% (group 3) (p<0.0001), whereas in patients with arteriovenous fistulae they were 33.7% (group 1), 35.7% (group 2), and 59.8% (group 3) (p=0.0005).


CONCLUSIONS
A surgical approach may cause difficulty in creating a new VA, because useful access vessels are limited. Our results indicate surgical balloon-angioplasty and ET provide the same patency. ET is less invasive and can be repeated, which makes it beneficial for the patients. We concluded ET could be considered as the first-line treatment for thrombotic complications.
Department of Internal Medicine, Nagoya Kyoritsu Hospital, Nagoya, Japan. yutaito@hkg.odn.ne.jp
Yutaka
Y
Ito
Takashi
T
Sato
Rei
R
Okada
Nobumasa
N
Nakamura
Keiko
K
Kimura
Ryo
R
Takahashi
Naofumi
N
Miwa
Hiroshi
H
Sakurai
Masato
M
Tsuboi
Hirotake
H
Kasuga
D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D018579:Patient Selection; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency