1
|
Wu V, Kalva SP, Cui J. Thrombectomy approach for access maintenance in the end stage renal disease population: a narrative review. Cardiovasc Diagn Ther 2023; 13:265-280. [PMID: 36864975 PMCID: PMC9971289 DOI: 10.21037/cdt-21-523] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022]
Abstract
Objective This article reviews current practices and outcomes in endovascular thrombectomy techniques for the treatment of thrombosed arteriovenous grafts (AVGs) and fistulas (AVFs). Background Arteriovenous (AV) access allows patients with end-stage renal disease (ESRD) to receive hemodialysis. Thrombosis of AV access can lead to delay in hemodialysis or abandonment of access requiring dialysis catheter placement. Endovascular approach has become the preferred treatment option for thrombosed access over surgery. Interventions include removal of thrombus from the AV circuit and treatment of the underlying anatomical abnormality, such as an anastomotic stenosis. Thrombolysis, or the act of dissolving thrombus, is performed by using infusion catheters or pulse injector devices for the administration of fibrinolytic agents. Thrombectomy, or the mechanical removal of thrombus, is performed by using embolectomy balloon catheters, rotating baskets or wires, rheolytic and aspiration mechanisms. Adjunctive methods such as cutting balloon angioplasty, drug-coated balloon (DCB) angioplasty, and stent placement are also used to treat stenoses in the AV circuit. Complications of these procedures include vessel rupture, arterial embolism, pulmonary embolism (PE), and paradoxical embolism to the brain. Methods This narrative review article was written based on literature search from electronic databases, including PubMed and Google Scholar. Conclusions The understanding of thrombectomy techniques and their potential complications is essential in the management of patients with thrombosed AV access.
Collapse
Affiliation(s)
- Vincent Wu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sanjeeva P. Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Jie Cui
- Nephrology Division, Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Hu X, Li B, Mao J, Hu X, Zhang J, Guo H, Wang D, Zhang Y, He J, Zhao N, Zhang H, Pang P. Hemodialysis Arteriovenous Fistula Dysfunction: Retrospective Comparison of Post-thrombotic Percutaneous Endovascular Interventions with Pre-emptive Angioplasty. Ann Vasc Surg 2022; 84:286-297. [PMID: 35247533 DOI: 10.1016/j.avsg.2022.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/11/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to compare the clinical outcomes of pre-emptive angioplasty versus post-thrombotic percutaneous endovascular restoration of dysfunctional arteriovenous fistula (AVF). METHODS This retrospective study reviewed data from 80 patients who underwent 114 endovascular interventions for a malfunctioning AVF from July 2016 to August 2019. Stenotic AVFs were treated with pre-emptive angioplasty. Thrombosed AVFs were treated with percutaneous pharmacomechanical fibrinolysis with urokinase used only during the operation or continuously infused. The differences in patency rates were evaluated using Kaplan-Meier method. In addition, univariate and multivariate regression Cox models were used to determine influential factors on the post-intervention primary patency. RESULTS Post-thrombotic interventions and pre-emptive angioplasty yielded statistically similar rates in clinical success (100% vs 100%), anatomic success (94% vs 89%; p = .52), complication (4% vs 11%; p = .29), as well as postintervention primary, assisted primary and secondary patency (p = .80; .57; .57). The use of pre-emptive angioplasty was associated with reduced total cost (¥25108 vs ¥30833, p< .001). The patients who used urokinase only during the operation prolonged both the primary and assisted primary patency (p = .02; .002), while those with continuous infusion of urokinase had worst patency rates and high costs (¥39275 vs ¥25108 vs ¥27140, p< .001). Compared with the other locations, dysfunction in the anastomotic or juxta-anastomotic segment (HR = .41, p = .001) was associated with prolonged postintervention primary patency. CONCLUSIONS No clinical outcome differences was found between the post-thrombotic percutaneous endovascular interventions and pre-emptive angioplasty. However, pre-emptive angioplasty decreased access expenditure.
Collapse
Affiliation(s)
- Xinyan Hu
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Bing Li
- Department of Ophthalmology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Junjie Mao
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Xiaojun Hu
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Jingjing Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Hui Guo
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Dashuai Wang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Yongyu Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Jianan He
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Ni Zhao
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Huitao Zhang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China
| | - Pengfei Pang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, 519000 P. R. China; Institute of Interventional Radiology, Sun Yat-sen University, Zhuhai, 519000 P. R. China.
| |
Collapse
|