D FERNANDES 1, S CHERIAN 1, B PAWAR 1, S THOMAS 1, S NAYAR 1, P GEORGE 1, M BROWN 1, S KODGIRE 1, M HAMILTON 1, S BALAKRISHNAN 1
1Alice Springs Hospital, Alice Springs, Australia
Aim: To analyse one year outcome of thrombectomies by endovascular interventions on Arterio-venous fistulae (AVF) and Arterio-venous grafts (AVG)
Background: The main complications of AVF and AVG are development of stenosis and thrombosis. Thrombosis of the fistula portends significant morbidity and mortality in dialysis patients. Percutaneous endovascular or surgical thrombectomies are treatment options to salvage a thrombosed fistula.
Methods: A retrospective study of all thrombectomies on AVF and AVG performed from 1st Dec 2008 to 30th April 2021 was conducted. Data were collected from the medical and radiology records. Patients in whom thrombectomies were not attempted and surgical thrombectomies were excluded. Patient with multiple episodes of thrombosis were included as separate event. The fistulae were analysed clinically and radiographically with ultrasound prior to the thrombectomy procedure. A combination of thrombolytic agent and balloon angioplasty catheters were used. Survival analysis test was done to assess one year patency of the vascular access after thrombectomy.
Results: In this period 31 patients underwent 39 thrombectomies, an average of 1.2 thrombectomies per vascular access. The mean age was 59.75+/-11.4 SD yrs. 52.5 % were females, 87.5% had coexisting diabetes mellitus. The commonest type of fistula was brachiocephalic (60%) and only 7% were grafts. Underlying stenotic lesions were most frequently observed in the Cephalic arch (32.26%) followed by multiple regions (19.35%), peripheral (16.13%), central (16.13%) and Juxta-anastomotic region (12.90%). 3.2% of target lesions were seen in the AVG. The mean 1 year survival was 237.2 +/-29.53 SD days and at 1 year 70 % of the vascular access which underwent thrombectomy were patent.
Conclusions: Endovascular thrombectomies are effective treatment options in prolonging the survival of the vascular access.
David Kiran Fernandes has been a part of Renal services team at Alice Springs Hospital, Northern Territory since 2007 and he has been involved in the interventional work in Central Australia since its inception in 2008. He graduated from the St John’s Medical College, Bangalore, India. Completed post-graduation and became a Lecturer in the Department of Nephrology, St John’s Medical College, Bangalore, India. David has completed specialist training in renal medicine under the tutelage of the renowned nephrologist, Late Professor J.C.M Shastry. Other interests include music and sports.