title: Hybrid simultaneous treatment of thrombosed prosthetic grafts for hemodialysis.
abstract: OBJECTIVE
  The aim of the study was to evaluate our experience in the hybrid simultaneous treatment (open and endovascular) of acute thrombosis of prosthetic grafts for hemodialysis.
  
  
  METHODS
  Between January 2011 and June 2013, 23 patients with acute thrombosis of a prosthetic graft for hemodialysis were urgently treated with a hybrid simultaneous treatment in order to obtain a prompt restoration of the flow. A new puncture of the graft was scheduled after 24 hours.
  
  
  RESULTS
  Intraoperative technical success was 100% with a completion angiography showing the restored patency of the graft. As adjunctive procedures, in 6 patients (26.1%) locoregional thrombolysis was necessary and in all cases further endovascular manoeuvres (angioplasty/stenting) were immediately performed to solve a significant stenosis of the venous anastomosis/first tract of the vein. At 24 hours when the first puncture was done, three grafts were occluded resulting in a primary patency of 87%. During the follow-up (mean duration 5.6 months) four reocclusions occurred. In-stent restenosis occurred in all patients undergone stenting. At 1 year the rates of primary patency, primary assisted patency and secondary patency were 58.7%, 78.3% and 87%, respectively.
  
  
  CONCLUSIONS
  In our series the combined simultaneous hybrid approach in urgency maximizes the use of different available techniques, which appeared to improve overall success rate to save a thrombosed graft for hemodialysis. The great difference showed between primary and primary assisted patency demonstrates the necessity of a close follow-up.
authors.affiliation: 2 Department of Cardiovascular Disease, Section of Vascular Surgery, Cliniche Humanitas Gavazzeni, Bergamo - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Troisi
authors.forename: Emiliano
authors.initials: E
authors.lastname: Chisci
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Frosini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Romano
authors.forename: Marco
authors.initials: M
authors.lastname: Setti
authors.forename: Giulio
authors.initials: G
authors.lastname: Mingardi
authors.forename: Stefano
authors.initials: S
authors.lastname: Michelagnoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012008:Recurrence; D006435:Renal Dialysis; D012086:Reoperation; D015607:Stents; D017131:Thrombectomy / Q000009:adverse effects; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency