Surgical or endovascular repair of thrombosed dialysis vascular access: Is there any evidence?

• Published in: Journal of vascular surgery 2009-10, Vol.50 (4), p.953-956
• Main Authors: Tordoir, Jan H.M., MD, PhD, Bode, Aron S., MD, Peppelenbosch, Noud, MD, PhD, van der Sande, Frank M., MD, PhD, de Haan, Michiel W., MD, PhD
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angioplasty - methods; Angioplasty, Balloon - methods; Arteriovenous Shunt, Surgical - adverse effects; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Graft Occlusion, Vascular - therapy; Humans; Intensive care medicine; Male; Medical sciences; Randomized Controlled Trials as Topic; Renal Dialysis - adverse effects; Renal Dialysis - methods; Risk Assessment; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombectomy - methods; Treatment Outcome; Vascular Patency - physiology; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2009.06.058

Introduction Endovascular and surgical strategies have been used to manage patients with thrombosed vascular access for hemodialysis. We analyzed the evidence to see whether endovascular or surgical treatment has the best outcome in terms of primary success rate and long-term patency. Methods We performed a systematic literature search of endovascular and surgical repair of thrombosed hemodialysis vascular access. The analysis included meta-analysis, randomized, and population-based studies of thrombosed arteriovenous fistulae and grafts. Results One meta-analysis and eight randomized studies on the treatment of arteriovenous graft thrombosis were identified. Studies conducted before 2002 demonstrated a significantly better primary success rate and primary and secondary patencies of surgical thrombectomy vs endovascular intervention. After 2002, similar results of both techniques have been reported. Only population-based studies on the treatment of thrombosed autogenous arteriovenous fistulae have been published, showing similar outcome of surgical and endovascular intervention in terms of primary success. The long-term primary and secondary patencies are slightly better for surgical treatment, but this concerns only forearm fistulae. Conclusions The outcome of endovascular and surgical intervention for thrombosed vascular access is comparable, in particular for thrombosed prosthetic grafts. Surgical treatment of autogenous arteriovenous fistulae is likely to have benefit compared with endovascular means. Definitive randomized trials are needed to provide the level 1 evidence to resolve this latter issue.