Different Modalities for Management of Thrombosed Arteriovenous Fistula: Multicenter Experience

Introduction: This study aims to report and evaluate different declotting modalities with their outcomes forsalvage of thrombosed native dialysis access.Patients and methods: Between March 2023 to March 2024, 70 patients with first time thrombosed nativearteriovenous fistula (AVF) were recruited, 27 radio-cephalic, 20 brachio-cephalic and 23 brachio-basilic AVFs weretreated either surgically with thrombectomy or endovascularly using different endovascular declotting concepts.Patients had follow-up at 1 week, 1, 3 and 6 months postoperatively.Results: In our study 15.7% (n=11/70) were treated with open thrombectomy and 84.3% (59/70) weretreated endovascularly using 5 different techniques. Techniques used were open surgical thrombectomy, balloonmaceration, pulse spray thrombolysis, mechanical thrombectomy (Aspirex device), aspiration thrombectomy(Penumbra device) and rheolytic mechanical thrombectomy (Angiojet device). Clinical success achieved in eachgroup was 72.7%, 70%, 69.2%, 100%, 100% and 90.9% respectively (p=0.175), with 6-month primary patency72.7%, 60%, 69.2%, 75%, 77.8% and 86.4%, respectively (p=0.629).Conclusions: Surgical and endovascular intervention for thrombosed AVFs have comparable early clinical successand short-term primary and secondary patency rates.