Successful treatment of the chronically thrombosed dialysis access graft: Resuscitation of dead grafts

The most common contributing cause of thrombosis of an arteriovenous graft (AVG) in the hemodialysis patient is the presence of venous stenosis. In the face of a recovery of renal function either spontaneously or as a result of renal transplantation, an AVG commonly thromboses. In cases in which the AVG was recently placed, it is unlikely to have had a significant anatomic lesion at the time function was lost. Even though the access that has been left untreated has become a "dead" AVG, it offers an opportunity for "resuscitation." Thirteen cases that met the specific criteria of being placed only a short period of time prior to thrombosis (3 weeks to 6 months), thrombosing after a return of renal function and having been left untreated (3 months to 8 years) were attempted over a 12 year period. The technique applied was modified from the one routinely used based on the presumption that very little or no thrombus was present. The effort was met with success in 8 of the 13 patients. After being opened, the AVG appeared to follow the same patency pattern as other AVGs. It appears that attempting restoration of function of an AVG meeting these criteria may be indicated. Limited experience using this approach in AVGs that do not meet these specific criteria has uniformly met with failure.