Evaluation of efficacy of open thrombectomy for recently thrombosed arteriovenous fistulae and synthetic grafts for hemodialysis

Introduction:Dialysis access complications are frequent concerns for hemodialysis patients,however maintaining a patent vascular access is still quite difficult,Arteriovenous (AV) access thrombosis remains a major morbidity,so declotting have to be performed before next hemodialysis session,aiming to avoid placement central venous catheters (CVC) or decrease time needed for it.Different techniques do exist to manage a thrombosed vascular access,including open thrombectomy,catheter-directed thrombolysis and use of different types of percutaneous thrombo-aspiration catheters and mechanical thrombectomy devices;it is still debatable which access salvage procedure is the most effective. Aim and objectives:Our study is a prospective clinical trial aiming at evaluating the effectiveness of open thrombectomy for the recently thrombosed AVF or AV grafts for hemodialysis patients,its patency rate and complications during the period of the study. Patient and Methods:our study was done at vascular Surgery Unit of Minia University Hospital.It was a prospective study that was performed on 50 patients with recently thrombosed AVF or graft.Patients were managed by open thrombectomy with venoplasty applied on selected cases. Result:The mean age was 57.1±11.9years.The cause of access thrombosis was found to be hypotension in 18(36%)patients,stenosis in 15patients(30%)and intimal hyperplasia in 7(14%).Intervention was successful to regain immediate functioning AVF in 43patients(86%),with a secondary patency rate for native AVF after 6 months of procedure was(71%),while cases with AV graft had a secondary patency rate of(73%)after same period. Conclusion:Our study supports that open thrombectomy for acutely thrombosed AV access has a high success rates,low complications and high secondary patency although results are getting better when venoplasty is added.