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Tay TKC, Rehena G, Zhuang KD, Irani FG, Gogna A, Too CW, Chong TT, Tan BS, Tan CS, Tay KH. Comparison of pharmacological thrombolysis with mechanical thrombectomy in thrombosed arteriovenous fistulas and grafts: a systemic review and meta-analysis. Clin Radiol 2024; 79:e624-e633. [PMID: 38320944 DOI: 10.1016/j.crad.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 02/08/2024]
Abstract
AIM To compare the effectiveness and safety of pharmacological thrombolysis and mechanical thrombectomy. MATERIAL AND METHODS This review was conducted in accordance with the PRISMA guidelines. Pooled proportions and subgroup analysis were calculated for primary and secondary patency rates, technical success, clinical success, major and minor complications rates. RESULTS This systematic review identified a total of 6,492 studies of which 17 studies were included for analysis. A total of 1,089 patients comprising 451 (41.4 %) and 638 (58.6 %) patients who underwent thrombolysis and mechanical thrombectomy procedures, respectively, were analysed. No significant differences were observed between thrombolysis and mechanical thrombectomy procedures in terms of technical success, clinical success, major and minor complications rates, primary and secondary patency rates; however, subgroup analysis of overall arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) demonstrated a significantly higher rate of major complications within the AVF group (p=0.0248). CONCLUSION The present meta-analysis suggests that pharmacological thrombolysis and mechanical thrombectomy procedures are similarly effective and safe; however, AVFs are subject to higher major complications compared to AVGs.
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Affiliation(s)
| | - G Rehena
- Duke-NUS Medical School, Singapore
| | - K D Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - F G Irani
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - A Gogna
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - C W Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - T T Chong
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - B S Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore
| | - C S Tan
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - K H Tay
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore.
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Zhan S, Zhang L, Xiao G, Wang Y. Creation of an arteriovenous graft for hemodialysis using a previously placed stent graft: A case report. J Vasc Access 2024; 25:658-662. [PMID: 36172644 DOI: 10.1177/11297298221124874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Successful hemodialysis (HD) treatment depends on well-functioning arteriovenous access. Thrombosis and stenosis are the main causes of access failure. The current report describes the successful establishment of an arteriovenous graft for HD using a previously placed stent graft in an HD patient who developed multiple episodes of access stenosis and thrombosis.
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Affiliation(s)
- Shen Zhan
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Lihong Zhang
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Guanghui Xiao
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
| | - Yuzhu Wang
- Department of Nephrology, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, China
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Rimal A, Karki B, Paudel A, Pradhan UL, Bhusal KR. Pulmonary embolism in an ESRD patient following minimal venotomy and milking for salvage of dysfunctional autogenous arteriovenous fistula. Clin Case Rep 2023; 11:e7042. [PMID: 36879679 PMCID: PMC9984676 DOI: 10.1002/ccr3.7042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Pulmonary embolism can be a complication following an attempted salvage of a dysfuctional arteriovenous fistula (AVF). We report a case of bilateral pulmonary embolism in a patient with underlying pericardial effusion who, following minimal venotomy and milking of the AVF, developed sudden and significant respiratory distress, and later improved.
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Affiliation(s)
- Ankit Rimal
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Bipin Karki
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Ashmita Paudel
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Utsav Lal Pradhan
- Department of Critical Care Medicine Tribhuvan University Teaching Hospital Kathmandu Nepal
| | - Kabi Raj Bhusal
- Department of Radiology Tribhuvan University Teaching Hospital Kathmandu Nepal
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Liu W, Wu M, Wang X, Huang XK, Cai WJ, Ding TY, Duan LL, Qiao R, Wu YG. Recanalization of thrombosed aneurysmal hemodialysis arterovenous fistulas using a hybrid technique based on data from a single center. BMC Nephrol 2022; 23:185. [PMID: 35568810 PMCID: PMC9107707 DOI: 10.1186/s12882-022-02820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022] Open
Abstract
Objective To explore the technical specifications and clinical outcomes of thrombosed aneurysmal haemodialysis arteriovenous fistula (AVF) treated with ultrasound-guided percutaneous transluminal angioplasty combined with minimal aneurysmotomy. Methods This case series study included 11 patients who had thrombosed aneurysmal AVF and underwent salvage procedures over a 13-month period. All procedures were performed under duplex guidance. Minimal aneurysmotomy was performed, along with manual thrombectomy and thrombolytic agent infusion, followed by angioplasty to macerate the thrombus and sufficiently dilate potential stenoses. A successful procedure was defined as immediate restoration of flow through the AVF. Results The 11 patients (four males and seven females) had a mean age of 49.6 years ± 11.9 years. Six patients (54.5%) had two or more aneurysms. The mean aneurysm maximal diameter was 21.5 mm (standard deviation: ± 5.0 mm), and the mean thrombus length was 12.9 cm (8–22 cm). Ten (83.3%) of the 12 procedures were technically successful. The mean duration of operation was 150.9 minutes (standard deviation: ± 34.2 minutes), and mean postoperative AVF blood flow was 728.6 ml/min (standard deviation: ± 53.7 mi/min). The resumption of hemodialysis was successful in all 11 cases, with a clinical success rate of 100%. The primary patency rates were 90.0% and 75.0% at three and four months over a mean follow-up time of 6.3 months (3–12 months). The secondary patency rates were 90.4% at three and four months. Conclusion A hybrid approach combining ultrasound-guided percutaneous transluminal angioplasty and minimal aneurysmotomy might be a safe and effective method for thrombosed aneurysmal AVF salvage.
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Affiliation(s)
- Wei Liu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, P.R. China.,Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Meng Wu
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Xu Wang
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Xiao-Kang Huang
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Wen-Jiao Cai
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Teng-Yun Ding
- Department of Ultrasonography, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Liang-Liang Duan
- Department of Nephropathy, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Rui Qiao
- Department of Cardiology, Anqing Municipal Hospital, Anqing, Anhui, 246000, P.R. China
| | - Yong-Gui Wu
- Department of Nephropathy, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230022, P.R. China. .,Center for Scientific Research, Anhui Medical University, Hefei, Anhui, 230022, P.R. China.
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García-Medina J, Maldonado-Cárceles AB, García-Alfonso JJ, Árense-Gonzalo JJ, Torres-Cantero AM. Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi. Clin Kidney J 2020; 14:814-819. [PMID: 33777364 PMCID: PMC7986443 DOI: 10.1093/ckj/sfz193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background Current evidence is insufficient to determine the contribution of stent grafts as treatment in partially thrombosed aneurysms or residual wall-adherent thrombi in arteriovenous fistulae (AVFs) for haemodialysis. The overall purpose of this study was to analyse patency rates of post-interventional covered stent deployment in those cases. We also assessed if patency rates differed when fistulas were punctured through the stent during dialysis sessions. Methods We conducted a retrospective study between 2006 and 2014 analysing post-intervention primary patency rates using the Kaplan-Meier log-rank test. Multivariate Cox proportional regression models were performed to determine if cannulation within the stent graft area was a potential risk factor for occlusion, by adjusted hazard ratio (HR). Results A total of 27 procedures were included in the study. Primary patency rates (%) after stent deployment at 3, 6, 12, 24, 36 and 72 months were, respectively: total 59, 32, 32, 21, 11 and 5; stent puncture 53, 21, 21, 16, 5 and 0; and no stent puncture 80, 80, 80, 40, 40 and 40. Cannulation through the stent graft was not significantly associated with increased risk of obstruction in multivariate analysis (HR = 3.01; P = 0.286). Conclusion Stent graft treatment may be a feasible procedure in partially thrombosed aneurysms and residual thrombi in AVF. Although fistulas punctured through the stent presented lower patency rates, this practice was not associated with a higher risk of obstruction. Giving the impossibility of comparing with similar approaches, further studies are needed to confirm or refute the advantages of this procedure.
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Affiliation(s)
- José García-Medina
- Department of Vascular and Interventional Radiology, General University Hospital "Reina Sofia", Murcia, Spain
| | - Ana B Maldonado-Cárceles
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Murcia, Spain.,Department of Preventive Medicine, General University Hospital "Reina Sofia", Murcia, Spain
| | - Juan J García-Alfonso
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Murcia, Spain
| | - Julián J Árense-Gonzalo
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Murcia, Spain
| | - Alberto M Torres-Cantero
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine, Murcia, Spain.,Department of Preventive Medicine, University Hospital "Virgen de la Arrixaca", Murcia, Spain
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Cho S. The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist. Kidney Res Clin Pract 2017; 36:175-181. [PMID: 28680825 PMCID: PMC5491164 DOI: 10.23876/j.krcp.2017.36.2.175] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/15/2017] [Accepted: 02/17/2017] [Indexed: 12/04/2022] Open
Abstract
Background Salvage of a thrombosed arteriovenous fistula (AVF) by secondary fistula conversion may be more effective than a conventional endovascular procedure for forearm fistula thrombosis. Surgical access procedures are an undeveloped area in interventional nephrology compared to endovascular procedures. Herein, the author report the results of surgical salvage of thrombosed AVFs by interventional nephrologists. Methods The author retrospectively analyzed 52 surgical salvage procedures for AVF thrombosis (radiocephalic fistula = 44 cases, brachiocephalic fistula = 8 cases) that were performed by interventional nephrologist between March 2007 and January 2016. Results Secondary fistula formation using the proximal vein was performed for 46 cases (88.5%); outflow rerouting was performed for two cephalic-arch stenosis cases (3.9%), simple thrombectomy was performed for two cases (3.9%), and a graft interposition was performed for two cases (3.9%). Technical success after the surgical procedures was achieved in 51 cases (98.1%), and 39 AVFs (75.0%) were prepared for immediate puncturing without catheter insertion. The primary and secondary patency rates for AVF at 6, 12, 18, and 24 months were 88.5%, 83.2%, 83.2%, and 83.2% and 96.0%, 96.0%, 93.2%, and 93.2%, respectively. The re-intervention rate was 0.27 ± 0.92/patient/ year. Conclusion Based on these results, the author conclude that surgical salvage of a thrombosed AVF, when performed under local anesthesia by a skilled interventional nephrologist, offers favorable short- and long-term success and should be the preferred treatment.
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Affiliation(s)
- Seong Cho
- Division of Nephrology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Dariushnia SR, Walker TG, Silberzweig JE, Annamalai G, Krishnamurthy V, Mitchell JW, Swan TL, Wojak JC, Nikolic B, Midia M. Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit. J Vasc Interv Radiol 2016; 27:1518-30. [DOI: 10.1016/j.jvir.2016.07.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023] Open
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Ahn SY, So YH, Choi YH, Jung IM, Chung JK. Endovascular recanalization of a thrombosed native arteriovenous fistula complicated with an aneurysm: technical aspects and outcomes. Korean J Radiol 2015; 16:349-56. [PMID: 25741197 PMCID: PMC4347271 DOI: 10.3348/kjr.2015.16.2.349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/03/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. MATERIALS AND 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. CONCLUSION Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.
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Affiliation(s)
- Su Yeon Ahn
- Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul 110-744, Korea
| | - Young Ho So
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea
| | - Young Ho Choi
- Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea
| | - In Mok Jung
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea
| | - Jung Kee Chung
- Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 156-707, Korea
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Simulation of Dialysis Access (SoDA) – Eight Stations Hands-On Dialysis Access Simulation. J Vasc Access 2014. [DOI: 10.5301/jva.2014.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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