Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion

Abstract

Introduction: Thrombosis is one of the most common complications of dialysis vascular access and is a significant source of morbidity and healthcare-associated costs. In this retrospective study, outcomes for surgical thrombectomy and thrombolysis after access thrombosis in patients with arteriovenous fistulas or prosthetic grafts (arteriovenous grafts) were analysed. Methods: All patients with a primary episode of dialysis access thrombosis between 2005 and 2013 were included which yielded 131 patients with 149 episodes of access thrombosis (108 arteriovenous grafts; 41 arteriovenous fistulas). In all, 18 patients had two separate accesses during the study. Patient demographics, access anatomy, surgical and radiological procedural data were recorded. Kaplan–Meier estimates and Poisson regression were used for statistical analysis of access patency. Results: In total, 107 underwent surgical thrombectomy and 42 were treated with catheter-directed thrombolytic infusion. Technical success was 60% for surgical thrombectomy and 73% for thrombolysis (p = 0.18). There were no major complications and no deaths within 30 days of the procedure. More patients had adjunctive procedures in the thrombolysis group (65/107 vs 37/42; p = 0.002). There was an increasing risk of rethrombosis or a further access-related event for both arteriovenous fistulas and arteriovenous grafts after open thrombectomy compared with catheter-directed thrombolytic infusion, and arteriovenous fistulas exhibited a lower risk than arteriovenous grafts with an average increase in risk of 23.9% (95% confidence interval: 3.1–49) between each treatment group. Conclusion: Thrombolysis for thrombosis of native and prosthetic dialysis accesses appears to yield better assisted primary patency compared to surgical thrombectomy. Our results suggest that thrombolysis may be considered the first-choice method for treating the thrombosed dialysis access.