Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae

Background We reviewed the efficacy of percutaneous intervention in acute thrombotic occlusion of native arteriovenous (AV) fistulae for hemodialysis. Methods. Eight-one percutaneous procedures were performed in 54 patients presenting with a clotted native dialysis fistula. There were 60 cases of a long-segment thrombosis of the fistula. In 20 cases, a small thrombus usually caused by an underlying severe stenosis was observed. A proximal arterial occlusion was seen in one case. Treatment depended on clot size and included balloon dilation (N = 20), mechanical thrombectomy with various devices (N = 58), as well as pharmacomechanical thrombolysis (N = 3). Results. Full restoration of flow was established in 72 cases (88.9%). Early reobstruction within 14 days occurred in eight cases (11.1%). Primary patency rates after a 1-, 3-, 6-, and 12-month period were 74, 63, 52, and 27%, respectively. Overall fistula patency was 75% after 3 months, 65% after 6 months, 51% after 12 months, and 22% after 24 months. Conclusions. Acute thrombotic occlusion of native AV fistulae is a major complication of hemodialysis. The results of treatment are believed to be less successful than thrombosis treatment in synthetic grafts. Our results, however, indicate the efficacy of percutaneous treatment in native fistulae, and demonstrate comparable technical results and patency rates.