TITLE

Tratamiento de las trombosis de prótesis arteriovenosas para hemodiálisis asociadas a estenosis anastomóticas venosas mediante trombectomía quirúrgica, stenting cubierto y angioplastia a alta presión

AUTHOR(S)
Calsina, Laura; Clará, Albert; Collado, Sílvia; Barbosa, Francesc; Martínez, Román; Mateos, Eduardo
PUB. DATE
July 2013
SOURCE
Nefrologia;2013, Vol. 33 Issue 4, p564
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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 with 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 with venous anastomotic stenosis (74.1% upper extremity) by open thrombectomy (miniincision 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 with 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.
ACCESSION #
91939433

 

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