Rheolytic Pharmacomechanical Thrombectomy in Renal Dialysis Arteriovenous Fistula and Graft Thrombosis: Outcomes from a Tertiary Hospital in Qatar

Purpose To investigate the ability to salvage an acutely thrombosed dialysis access using rheolytic pharmacomechanical thrombectomy (PMT), the short- and mediumterm patency rates and safety at a tertiary care hospital. Methods A retrospective review of all patients who underwent rheolytic PMT for a thrombosed arteriovenous fistula (AVF) or arteriovenous graft (AVG) from October 2020 to 2023 was performed. Primary patency was defined as the ability to successfully dialyze through the treated access site without further intervention. Secondary patency included patients who required additional interventions that enabled them to continue dialysis. Data analysis was conducted using SPSS for comprehensive statistical evaluation. Results A total of 37 thrombectomy procedures, involving 15 AVF and 22 AVG cases, were performed on 31 patients; 20 males and 11 females with a mean age of 62±13 years. The average time from recognizing dialysis access site dysfunction to intervention was 2.6±1.4 days. Themean total rheolytic PMTrun time was 295±119 seconds. Immediate technical success was defined as restoration of flow between the arteriovenous anastomosis and the central veins. Technical success was achieved in 91.9% (34/37) of thrombectomies. Clinical success was defined as the ability to achieve successful dialysis within 48 hours of the intervention. In total, 72.9% (27/37) of these cases achieved clinical success. Primary patency rates at 1, 3, and 6 months were 87.5, 78, and 46.9%, respectively. Secondary patency rates at 3, 6, and 12 months were 87.5, 66.7, and 58.3%, respectively. Angioplasty was performed in all procedures, and stent insertion was required in 13.5% (5/37) of thrombectomies. Conclusion This study adds to the evidence that rheolytic PMT is a safe and effective tool for AVF and AVG salvage. After an initial thrombosis, the chance of re-thrombosis within 12 to 24 months is high and teams looking after these patients should have a strategy for future dialysis access.