Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts

Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the...

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Autores principales:	You Kyeong Park, Jae Woong Lim, Chang Woo Choi, Keun Her, Hwa Kyun Shin, Sung Ho Shinn
Formato:	article
Lenguaje:	EN
Publicado:	Korean Society for Thoracic & Cardiovascular Surgery 2021
Materias:	surgical arteriovenous shunt vascular graft occlusion thrombectomy shunts Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/840fdb36825b42518a3a5ee28987d999
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spelling	oai:doaj.org-article:840fdb36825b42518a3a5ee28987d9992021-12-03T01:37:23ZComparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts10.5090/jcs.21.0672765-16062765-1614https://doaj.org/article/840fdb36825b42518a3a5ee28987d9992021-12-01T00:00:00Zhttps://doaj.org/toc/2765-1606https://doaj.org/toc/2765-1614Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519–0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.You Kyeong ParkJae Woong LimChang Woo ChoiKeun HerHwa Kyun ShinSung Ho ShinnKorean Society for Thoracic & Cardiovascular Surgeryarticlesurgical arteriovenous shuntvascular graft occlusionthrombectomyshuntsMedicine (General)R5-920ENJournal of Chest Surgery, Vol 54, Iss 6, Pp 500-508 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	surgical arteriovenous shunt vascular graft occlusion thrombectomy shunts Medicine (General) R5-920
spellingShingle	surgical arteriovenous shunt vascular graft occlusion thrombectomy shunts Medicine (General) R5-920 You Kyeong Park Jae Woong Lim Chang Woo Choi Keun Her Hwa Kyun Shin Sung Ho Shinn Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts
description	Background: The major limitation of arteriovenous graft access is the high incidence of thrombotic occlusion. This study investigated the outcomes of our salvage strategy for thrombosed hemodialysis arteriovenous grafts (including surgical thrombectomy with balloon angioplasty) and evaluated the efficacy of intragraft curettage. Methods: Salvage operations were performed for 290 thrombotic occluded arteriovenous grafts with clinical stenotic lesions from 2010 to 2018. Of these, 117 grafts received surgical thrombectomy and balloon angioplasty from 2010 to 2012 (group A), and 173 grafts received surgical thrombectomy and balloon angioplasty, with an additional salvage procedure using a curette and a graft thrombectomy catheter, from 2013 to 2018 (group B). Outcomes were described in terms of post-intervention primary patency and secondary patency rates. Results: The post-intervention primary patency rates in groups A and B were 44.2% and 66.1% at 6 months and 23.0% and 38.3% at 12 months, respectively (p=0.003). The post-intervention secondary patency rates were 87.6% and 92.6% at 6 months and 79.7% and 85.0% at 12 months, respectively (p=0.623). Multivariate Cox regression analysis demonstrated that intragraft curettage was a positive predictor of post-intervention primary patency (hazard ratio, 0.700; 95% confidence interval, 0.519–0.943; p=0.019). Conclusion: Surgical thrombectomy and balloon angioplasty showed acceptable outcomes concerning post-intervention primary and secondary patency rates. Additionally, intragraft curettage may offer better patency to salvage thrombotic occluded arteriovenous grafts with intragraft stenosis.
format	article
author	You Kyeong Park Jae Woong Lim Chang Woo Choi Keun Her Hwa Kyun Shin Sung Ho Shinn
author_facet	You Kyeong Park Jae Woong Lim Chang Woo Choi Keun Her Hwa Kyun Shin Sung Ho Shinn
author_sort	You Kyeong Park
title	Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts
title_short	Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts
title_full	Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts
title_fullStr	Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts
title_full_unstemmed	Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts
title_sort	comparison of clinical outcomes in patients undergoing a salvage procedure for thrombosed hemodialysis arteriovenous grafts
publisher	Korean Society for Thoracic & Cardiovascular Surgery
publishDate	2021
url	https://doaj.org/article/840fdb36825b42518a3a5ee28987d999
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Comparison of Clinical Outcomes in Patients Undergoing a Salvage Procedure for Thrombosed Hemodialysis Arteriovenous Grafts

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