Early surgical thrombectomy improves salvage of thrombosed vascular accesses.
OBJECTIVE
The timing and urgency of salvage attempts for acutely thrombosed hemodialysis vascular accesses remain poorly defined. We examined the outcome of early surgical thrombectomy after acute access thrombosis to assess the influence of expedited timing on access salvage.


METHODS
Between January 2007 and October 2012, 114 surgical thrombectomy attempts were performed on 82 patients to salvage 89 accesses. The time between the diagnosis of thrombosis and admission to the operative suite (T1), the time between diagnosis and the following dialysis session (T2), and clinical and biologic parameters were collected prospectively. Data were retrospectively compared between the early (T1 <6 hours) and later (T1 >6 hours) treatment groups. The main outcome measure was technical success. Kaplan-Meier survival analysis was used to estimate functional patency rates.


RESULTS
Mean patient follow-up was 22 ± 18 months. The mean time from referral to procedure (T1) was 5.7 ± 4.5 hours. The mean time T1 was 3.6 ± 1.2 hours in the early group and 10.3 ± 5.4 hours in the later group. The mean time to dialysis (T2) was 14.3 ± 6.5 hours in the early group and 23.9 ± 9.4 hours in the later group. Thrombectomy performed ≤ 6 hours after diagnosis (T1 <6 hours) had significantly higher technical success of 86% compared with 69% for thrombectomy performed later (T1 >6 hours; P = .04). The two groups did not differ significantly in patient comorbidities, type of access, or adjunctive procedures performed (P ≥ .1). At 12 months, the primary patency rate for all index cases, including technical failures, was 55% ± 7.1% in the early group and 33% ± 9.7% in the later group (P = .13). The secondary patency rate was 67% ± 6.8% in the early group and 50% ± 9.9% in the later group (P = .05).


CONCLUSIONS
After acute access thrombosis, early surgical thrombectomy was associated with higher technical success and potentially improved midterm patency.
University of Nice Sophia Antipolis, Nice, France; Department of Vascular Surgery, University Hospital of Nice, Nice, France.
Nirvana
N
Sadaghianloo
University of Nice Sophia Antipolis, Nice, France; Department of Vascular Surgery, University Hospital of Nice, Nice, France.
Elixène
E
Jean-Baptiste
Department of Nephrology-Hemodialysis, Princess Grace Hospital Centre, Monte Carlo, Principality of Monaco.
Hacène
H
Gaid
University of Nice Sophia Antipolis, Nice, France; Department of Hemodialysis, University Hospital of Nice, Nice, France.
Mohamed S
MS
Islam
Department of Nephrology-Hemodialysis, Princess Grace Hospital Centre, Monte Carlo, Principality of Monaco.
Christophe
C
Robino
University of Nice Sophia Antipolis, Nice, France; Department of Vascular Surgery, University Hospital of Nice, Nice, France.
Serge
S
Declemy
Department of Surgery, Yale University School of Medicine, New Haven, Conn.
Alan
A
Dardik
University of Nice Sophia Antipolis, Nice, France; Department of Vascular Surgery, University Hospital of Nice, Nice, France. Electronic address: hassen-khodja.r@chu-nice.fr.
Réda
R
Hassen-Khodja
D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D061345:Early Medical Intervention; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010343:Patient Admission; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy; D017131:Thrombectomy; D013927:Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014654:Vascular Patency