RY TAN1, S TEH1, S PANG1, A GOGNA2, T CHONG3, K LEE1, C TAN1
1Department of Renal Medicine, Singapore General Hospital, , Singapore, 2Department of Vascular and Interventional Radiology, Singapore General Hospital, , Singapore, 3Department of Vascular Surgery, Singapore General Hospital, , Singapore
Aim: We aim to report the outcomes of clotted vascular access salvaged using endovascular technique and investigate for predictors of poor patency following intervention.
Background: Endovascular techniques have been increasing used to salvage clotted hemodialysis vascular access.
Methods: We studied a retrospective cohort of incident patients who underwent salvage of clotted vascular access using endovascular technique from 1 March 2015 to 31 December 2017, determined the technical and clinical success rates and complication rates and investigated for predictors of poor patency following intervention.
Results: A total of 311 incident patients (mean age 63.8 ± 11.6) underwent endovascular thrombectomy during the study period. Of which, 53.7% were arteriovenous fistula (AVF) while 46.3% were arteriovenous graft (AVG). 96.5% of the interventions were successful radiologically but only 93.2% of patients had successful dialysis with the intervened access. Complications occurred in 31 (10%) interventions. Thrombosis-free survivals for AVF vs. AVG were 195.7 ±176 vs.145 ± 154.4 days respectively. (p=0.01). After adjusting for patient age, presence of diabetes mellitus, thrombolytic agent used and the use of cutting balloon, drug-eluting balloon and stents; AVG (adjusted OR 1.528, 95% CI 1.119-2.087, p 0.008) and prior thrombolysis within 90 days (adjusted OR 2.121, 95% CI 1.142-3.168, p <0.0001) were found to be significantly associated with poor patency post intervention.
Conclusion: Although most clotted vascular access can be successfully salvaged using endovascular techniques, long-term patency remains poor. Novel therapy should be explored to improve the long-term patency of vascular access post-thrombectomy.
Dr Tan Ru Yu is a Consultant with the Department of Renal Medicine. She graduated with MBBS from International Medical University of Malaysia in 2005 and obtained Membership of the Royal College of Physicians (UK) in 2010. Dr Tan completed advanced specialist training in Renal Medicine 2014. Clinical interests include general nephrology, interventional nephrology, hemodialysis and critical care nephrology.