title: Treatment of arteriovenous haemodialysis graft thrombosis associated to venous anastomotic stenosis by surgical thrombectomy, covered stenting and high-pressure angioplasty.
abstract: OBJECTIVE
  The NKF-K/DOQI guidelines recommend that the repermeabilisation of thrombosed arteriovenous (AV) grafts for haemodialysis must achieve positive results in 40% at 3 months, if it is performed by endovascular technique, or 50% at 6 months and 40% at one year if it is performed by surgical procedure. This study assesses the results of a hybrid treatment (minimally invasive surgical and endovascular treatment) of AV graft thrombosis associated to venous anastomotic stenosis.
  
  
  METHODS
  Between 2008 and 2012, 27 consecutive patients underwent surgery (average age: 69.7, 52% male) due to AV graft thrombosis associated to venous anastomotic stenosis (74.1% upper extremity) by open thrombectomy (mini-incision in the graft), covered self-expanding stent (Fluency, Bard), and high pressure angioplasty (>20atm).
  
  
  RESULTS
  Immediate patency with effective haemodialysis was 89%, with an average stay of 1.9 days and no postoperative complications. Primary patency at 3, 6, and 12 months was 51.9%, 44.4%, and 16.2% respectively (mean follow-up: 15 months). Secondary patency after a new thrombotic episode and similar procedure (62.9% of cases) was 70.4%, 51.9%, and 37% respectively.
  
  
  CONCLUSIONS
  Despite being safe and minimally invasive, this hybrid treatment for AV graft thrombosis associated to venous anastomotic stenosis only achieves competitive results compared to open surgery after a second iterative procedure. Because of this and the associated costs, this technique should be reserved for difficult surgical approach stenoses.
authors.affiliation: Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Barcelona, Spain. lcalsina@hospitaldelmar.cat
authors.forename: Laura
authors.initials: L
authors.lastname: Calsina
authors.forename: Albert
authors.initials: A
authors.lastname: Clará
authors.forename: Sílvia
authors.initials: S
authors.lastname: Collado
authors.forename: Francesc
authors.initials: F
authors.lastname: Barbosa
authors.forename: Román
authors.initials: R
authors.lastname: Martínez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mateos
mesh_terms: D000368:Aged; D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000295:instrumentation*; D015607:Stents; D017131:Thrombectomy; D013927:Thrombosis / Q000209:etiology* / Q000628:therapy*