Transcatheter Thrombolysis with Percutaneous Transluminal Angioplasty Using a Trans-Brachial Approach to Treat Thrombosed Arteriovenous Fistulas

Abstract

Background

Arteriovenous fistulas (AVFs) are used to provide vascular access for hemodialysis in patients with end-stage renal failure. However, stenosis and thrombosis can compromise long-term AVF patency. The objective of this study was to evaluate catheter thrombolysis with percutaneous transluminal angioplasty (PTA), using a trans-brachial approach, for acutely thrombosed AVFs.

Material/Methods

This retrospective study examined 30 cases of AVF thrombosis treated between January 1, 2015 and January 1, 2017. All patients received transcatheter thrombolysis with PTA using a trans-brachial approach. AVF patency was assessed after 6 months.

Results

Thrombolysis with PTA was performed at 2 to 72 h after diagnosis of AVF occlusion due to acute thrombosis, and AVF patency was restored in all patients. After 6 months, the primary and secondary patency rates were 76.7% and 93.3%, respectively. For type I stenosis, primary patency was achieved in 10 of 16 patients (62.5%) and secondary patency was achieved in 14 of 16 patients (87.5%). For type II stenosis, primary patency was achieved in 13 of 14 patients (92.9%) and secondary patency was achieved in 14 of 14 patients (100%). Comparing type I and II stenosis, a significant difference was detected in the rates of primary patency (odds ratio=0.909, 95% confidence interval 0.754–1.096, P=0.049), but not secondary patency (P=0.178), after 6 months.

Conclusions

Our study provides preliminary evidence that catheter-directed thrombolysis with PTA using a trans-brachial approach can achieve high patency rates when used to treat acutely thrombosed AVFs.