Resumo

CALSINA, Laura et al. Treatment of arteriovenous haemodialysis graft thrombosis associated to venous anastomotic stenosis by surgical thrombectomy, covered stenting and high-pressure angioplasty. Nefrología (Madr.) [online]. 2013, vol.33, n.4, pp.564-570. ISSN 1989-2284.  https://dx.doi.org/10.3265/Nefrologia.pre2012.Nov.11756.

Introduction/objective: The NKF-K/DOQI guidelines recommend that the repermeabilisation of thrombosed arteriovenous (AV) grafts for haemodialysis must achieve positive results in 40% at 3 months, if it is performed by endovascular technique, or 50% at 6 months and 40% at one year if it is performed by surgical procedure. This study assesses the results of a hybrid treatment (minimally invasive surgical and endovascular treatment) of AV graft thrombosis associated to venous anastomotic stenosis. Patients and Method: Between 2008 and 2012, 27 consecutive patients underwent surgery (average age: 69.7, 52% male) due to AV graft thrombosis associated to venous anastomotic stenosis (74.1% upper extremity) by open thrombectomy (mini-incision in the graft), covered self-expanding stent (Fluency^®, Bard), and high pressure angioplasty (>20atm). Results: Immediate patency with effective haemodialysis was 89%, with an average stay of 1.9 days and no postoperative complications. Primary patency at 3, 6, and 12 months was 51.9%, 44.4%, and 16.2% respectively (mean follow-up: 15 months). Secondary patency after a new thrombotic episode and similar procedure (62.9% of cases) was 70.4%, 51.9%, and 37% respectively. Conclusions: Despite being safe and minimally invasive, this hybrid treatment for AV graft thrombosis associated to venous anastomotic stenosis only achieves competitive results compared to open surgery after a second iterative procedure. Because of this and the associated costs, this technique should be reserved for difficult surgical approach stenoses.

Palavras-chave : Arteriovenous graft; Thrombosis; Thrombectomy; Angioplasty.

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