Salvage of thrombosed arteriovenous fistulae of patients on hemodialysis: report on the experience of a Brazilian center

Abstract

INTRODUCTION: Hemodialysis vascular access thrombosis is an acute event that can interrupt the dialytic treatment. A timely management can restore access patency, avoiding the use of central venous catheters and their complications. OBJECTIVE: To present the experience from a Brazilian Interventional Nephrology Center (INC) in the salvage of arteriovenous fistula (AVF) and grafts for hemodialysis. METHODS: A retrospective study was performed to evaluate the primary and secondary patencies of 41 hemodialysis accesses with thrombosis confirmed by ultrasound and submitted to endovascular salvage procedures. We considered clinical success the use of the access for at least 3 subsequent hemodialysis sessions. The procedures were done in an outpatient center by interventional nephrologists. Patients were followed for up to 18 months with Doppler every 3 months. RESULTS: Forty-five salvage procedures were performed in 41 accesses of 40 hemodialysis patients with native AVF or grafts. Of these, 90% were AVF, mostly upper arm, and 10% were grafts. Clinical success rate was 60% (27 procedures). Primary patency at 12 months was 39% and secondary was 52%. Gender of the patient, diabetes, and location of the access did not correlate statistically with outcomes. There were 3 major complications (anastomosis rupture, grade 3 hematoma, and anaphylactic shock). CONCLUSION: The majority of thrombosed accesses can be successfully treated, maintaining its long-term patency. The need of repeated intervention is frequent.