title: Thrombectomy of arteriovenous dialysis grafts with early failure: is it worthwhile?
abstract: Arteriovenous dialysis grafts are prone to frequent thrombosis, which can be treated either percutaneously or surgically. To assess the outcomes of grafts treated for early thrombosis, we retrospectively queried a prospective, computerized database, and identified all grafts placed over a 5-year period that required thrombectomy within 60 days of creation. Technical success was defined as the immediate restoration of graft patency. Primary patency was calculated from thrombectomy to the next intervention, and cumulative graft survival from thrombectomy to permanent graft failure. Of 709 grafts placed, 98 grafts (14%) clotted within 60 days of creation, including 63 (9%) within 30 days of graft creation, and 35 (5%) at 31-60 days after creation. Most (95%) of grafts clotting within 30 days of creation underwent surgical thrombectomy, whereas 71% of those clotting at 31-60 days underwent percutaneous thrombectomy. The immediate technical success was 82% and 80% in grafts undergoing thrombectomy at <30 vs. 31-60 days (p = 0.76). The median primary patency was 11 and 23 days (p = 0.46), and the median cumulative graft survival was 27 and 163 days, respectively (p = 0.29). In conclusion, thrombectomy within 60 days of graft creation is associated with poor primary and cumulative graft patency, and may not be worthwhile.
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, Alabama, USA.
authors.forename: Vijay
authors.initials: V
authors.lastname: Mudunuri
authors.forename: Jeremy C
authors.initials: JC
authors.lastname: O'Neal
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors