Endovascular recanalization of a thrombosed native arteriovenous fistula complicated with an aneurysm: technical aspects and outcomes.
OBJECTIVE
To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm.


METHODS
Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis.


RESULTS
The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively.


CONCLUSIONS
Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.
Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul 110-744, Korea.
Su Yeon
SY
Ahn
Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea.
Young Ho
YH
So
Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea.
Young Ho
YH
Choi
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea.
In Mok
IM
Jung
Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea.
Jung Kee
JK
Chung
D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000150:complications / Q000601:surgery*; D000800:Angioplasty, Balloon; D001164:Arteriovenous Fistula / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000150:complications; D057510:Endovascular Procedures; D004868:Equipment Failure; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014654:Vascular Patency; D014680:Veins
D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator
Aneurysm; Arteriovenous fistula; Thrombectomy; Thrombosis