Abstract: SA-PO957
Likelihood of Failed Thrombectomy (LOFT)
Session Information
- Dialysis: Vascular Access - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 704 Dialysis: Vascular Access
Authors
- Ribeiro, Phillip, Vanderbilt University, NASHVILLE, Tennessee, United States
- Qazi, Moarij A., UNLV, LAS VEGAS, Nevada, United States
- Morse, Jennifer, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Stewart, Thomas G., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Qazi, Rizwan A., KSOSN, Las Vegas, Nevada, United States
Background
Currently percutaneous thrombectomy (PCT) is widely used for clot removal, however if unsuccessful, the patient is referred for open surgical thrombectomy. The current literature suggests that the success rates for thrombolysis of thrombosed fistulas ranges from 76-96%. To date it is unknown what risk factors and or access characteristics result in PCT failure.
Methods
Retrospective single center study including 212 hemodialysis patients, with 179 successful and 33 failed dialysis access thrombectomies. The following characteristics were evaluated for each patient: age, sex, diabetes, clot burden, central venous stenosis, presence of ≥ 2 aneurysms, previous stent placement, on outpatient anticoagulation, SBP<100mmHg, type and location of access, venous outflow stenosis, juxta-anastomotic stenosis, feeding artery diameter, arterial anastomotic stenosis, mid access stenosis, use of TPA or teratola, time of procedure, and presence of venous outflow stenosis. To assess the impacts of several risk factors, we constructed various models of success as a function of age group, sex, diabetes, and one of the other risk factors. The Holm-bonferroni step down method was used to adjust the p-values to deal with familywise error rates for multiple hypothesis tests.
Results
Risk factors for failed thrombectomies included the presence of ≥ 2 aneurysms and or patients with a forearm access. Patients with AV grafts and or venous outflow stenosis had significantly longer procedure times, and the use of teratola or TPA in patients with AV grafts did not affect PCT outcomes.
Conclusion
Our data illustrates that two indepednent risk factors for PCT failure include patients with a forearm access and or the presence of ≥ 2 aneurysms. A patient with both of these independent risk factors is perhaps better off being sent directly for open surgical thrombectomy. Moving forward, larger trials and a larger sample size are needed in order to prove the aforementioned results.
Plot Confidence Intervals