Assessing the approach to a thrombosed AV graft.
The patency of the vascular access (VA) is a fight for the attending nephrologist. A retrospective observational study was conducted to compare the success rate of surgical versus endovascular technique percutaneous transluminal angioplasty (PTA) for graft thrombosis treatment. Of 3008 patients, 22.1% patients were dialyzed through grafts. Forty-five percent of all prevalent patients referred due to VA malfunction had a graft. For 18 months, 336 thrombosed grafts were submitted to surgery in 228 cases and to PTA in 126. PTA for thrombolysis included the Pharmaco-Mechanical Technique and the Arrow-Trerotola Device. Procedures were performed as outpatient, with an average delay of 1 day. Immediate success was 100% for surgery and 87.3% for PTA. The unassisted patency for thrombosed grafts for surgery/PTA was 265.12 ± 15.30/230.59 ± 19.83 days respectively, favoring surgery. The primary patency for thrombosed grafts treated by surgery/PTA at 30, 90, and 180 days was, respectively, 74.1%/81%, 63.2%/67.5%, and 53.9%/55.6% all in favor of PTA. AV grafts have a much higher rate of thrombosis than fistulas. Graft thrombosis can be dealt either by surgery or PTA, with identical success.
Vascular Access Centre, NephroCare Portugal, Lisboa, Portugal.
Pedro
P
Ponce
Telmo
T
Carvalho
Humberto
H
Messias
Fernando
F
Neves
D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D011446:Prospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency