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Surgical Salvage of Thrombosed Arteriovenous Fistulas and Grafts

Abstract:  Our clinical experience with surgical salvage of thrombosed arteriovenous (AV) fistula and grafts, performed by a skilled interventional nephrologist is presented. A total of 286 surgical interventions were performed in 246 chronic hemodialysis patients aged 12–87 years (55 ± 16 years), 268/286 (93.7%) in AV fistulas, 18/286 (6.3%) in grafts, and analyzed retrospectively. A subgroup of 61 procedures was analyzed prospectively. The type of procedure, immediate success and patency after surgery were evaluated. Thrombectomy with reanastomosis was performed in 197/286 (68.9%) and simple thrombectomy in 89/286 (31.1%) of the procedures. The time from thrombosis to surgery was 1–60 days (3.7 ± 1.8). Immediate success was achieved in 258/286 (90.2%) of surgical procedures, 95.5% (189/198) in thrombectomies with reanastomosis, and 77.5% (69/89) in simple thrombectomies. Primary and secondary patency rates for AV fistulas after surgical salvage at 3, 6, 9, and 12 months were 93.1, 84.0, 78.3, 75.0% and 96.6, 88.0, 78.3, 77.3%, respectively. In order to maintain secondary patency, 1.15 surgical procedures per AV fistula were needed. The time to thrombosis in grafts was on average 10.2 months, primary and secondary functioning time from thrombectomy (until the end of observation period) was from 1 to 19 months (average 6.9 ± 6.3 months) and from 5.5 to 19 months (average 9.1 ± 5.6 months), respectively. In 7/16 (43.8%) surgical procedures, transluminal angioplasty and in 3/16 endovascular stent was placed after angioplasty. To maintain secondary patency, 2.3 surgical procedures per graft were needed. The surgical salvage of thrombosed AV fistulas and grafts, performed by a skilled interventional nephrologist, is successful in the short and long‐term.