Clinical Experiences of Balloon Angioplasty with or without Surgical Thrombectomy in Salvage of Failing/failed Hemodialysis Access

Abstract

Objective: Maintenance of adequate blood flow in hemodialysis (HD) access (AVF; arteriovenous fistula and AVG; arteriovenous graft) is critical in patients with end-stage renal disease. This study was performed to evaluate the results of a rescue therapy for failing/thrombosed HD access. Methods: From April 2007 to July 2015, 1421 and 1022 operations were performed for failing and thrombosed HD access respectively. Among these operations, 1230 (611 for AVG, 619 for AVF) percutaneous balloon angioplasty (PTA) and 650 (434 for AVG, 216 for AVF) surgical thrombectomy with/without balloon angioplasty (ST (+BA)) were included. Initial success rate, morbidity, and procedure time were evaluated. Results: Procedure time of PTA and ST (+BA) were shorter in AVG compared to those in AVF (23 min vs 29 min, 52 min vs 66 min, respectively). Initial success rate of PTA and ST (+BA) were 99% and 96% in AVG, 99% and 90% in AVF. Success rate of ST (+BA) in AVF were statistically inferior to that in AVG (p<0.001). Morbidity of PTA and ST (+BA) were 0.5% and 1.9% in AVG, 0.5% and 5% in AVF. Most observed morbidity was perforation of blood vessels (0.5% in PTA, 3.2% in ST (+BA)). Vascular injury caused by guide-wires or balloon were initially rescued surgically but recently managed with prolonged balloon inflation. Conclusion: Resluts of PTA for failing AVG and AVF were excellent. Mean procedure time was 20–30 min and success rate were more than 99% in both group. Although results of ST (+BA) were still acceptable (mean procedure time was within 1 hour and success rate was more than 90% in both group), those in AVF were statistically inferior to those in AVG.