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Kidney Week

Abstract: TH-PO346

An Endovascular Treatment System for Occluded Native Arteriovenous Fistula

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Leo, Christopher Cheang Han, National University Hospital, Singapore, Singapore
  • Swinnen, Jan, Westmead Hospital, Sydney, New South Wales, Australia
Background

Westmead Hospital looks after a high number of patients on haemodialysis and because of the superior outcomes achieved with our endovascular techniques in occluded fistulas, from 2005 onwards, all patients who presented with an occluded native arteriovenous fistula (nAVF) to the Western Renal Area institution, were referred to our unit. We have also developed minimally invasive techniques to mature and repair dysfunctional nAVF including techniques to reestablish the flow through a thrombosed nAVF. The aim of this study is to present the techniques and results of the Endovascular Treatment System that we have developed for managing the occluded nAVF.

Methods

The current study is a retrospective chart review on all patients who presented with an occluded nAVF and underwent attempted resuscitation between the 1st January 2005 to 31st of December 2014.

Results

130 patients were included in the study. Post intervention primary access patency was 83.8% at 6 months, 78.7% at 12 months, 64.6% at 2 years and 59.6% at 3 years. Post intervention assisted access patency in fistulas-in-use was 86.5% at 6 months, 81% at 12 months, 66.8% at 2 years and 61.2% at 3 years. Post intervention secondary patency for all cases was 84.7% at 6 months, 80.2% at 12 months, 66.1% at 2 years and 62% at 3 years. Post intervention secondary patency in fistula-in-use was 91.1% at 6 months, 90% at 12 months, 85% at 2 years and 74.6% at 3 years. Neither access survival nor patency differed significantly when incisional thrombectomy was compared to angioplasty with or without stenting with access survival of 91.2% and 92.5% at 12 months and access patency of 82.9% and 89.7% at 12 months (p = .834 and p =.898 respectively).

Conclusion

In autologous arteriovenous thrombosed fistulae the use of purely endovascular techniques to revive the access is a viable and safe technique to employ in most cases.