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Kidney Week

Abstract: PO1345

Surgical or Endovascular Intervention for Dialysis Access Thrombosis?

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Hahn Lundström, Ulrika, Karolinska institutet Department of Clinical Sciences Intervention and Technology, Stockholm, Sweden
  • Welander, Gunilla, Uppsala University Department of Medical Sciences, Uppsala, Sweden
  • Carrero, Juan Jesus, Karolinska Institutet Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden
  • Hedin, Ulf, Karolinska Institutet Department of Molecular Medicine and Surgery, Stockholm, Sweden
  • Evans, Marie, Karolinska institutet Department of Clinical Sciences Intervention and Technology, Stockholm, Sweden
Background

Thrombosis is the most common cause of arterio-venous (AV) access failure in patients on hemodialysis. It is unknown if this complication is best treated by surgical or endovascular intervention. We compared the influence of surgical or endovascular intervention for AV access thrombosis on access survival using real-life data from a national AV access registry.

Methods

Patients from the Swedish Renal Access Registry (SRR-Access) with a prevalent and functional AV access who underwent surgical or endovascular intervention for their first thrombosis between Jan 1, 2008 and April 20, 2020 were included. The primary outcome was access survival. Secondary outcomes were time to next intervention and 30-day mortality. Access characteristics (date for access creation, upper or forearm access, graft or fistulae, first cannulation, date of thrombosis and time to next intervention) were obtained from SRR-Access. Patient characteristics were collected from SRR (age, sex, primary renal disease, comorbidities and start date of dialysis).
The outcomes were assessed with Cox proportional hazard regression models adjusted for demographics, clinical, and access variables (previous interventions and time to first thrombosis). Analyses were stratified by age, sex, type of access and comorbidities.

Results

In total, 904 patients with access thrombosis were included. The mean age was 62 years, 60% were women. A large proportion (75%) had hypertension, 33% had diabetes, 54% were fistulas and 35% upper arm accesses. The median follow-up time was 1.1 year (0.2-2.9). The adjusted total risk of access abandonment was increased if the thrombosis was treated with surgical thrombectomy, HR 1.22 (1.04-1.44). There was no significant difference in time to next intervention or mortality. The results were consistent within subgroups.

Conclusion

Endovascular intervention was associated with better long-term access survival in hemodialysis patients with AV access thrombosis.