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Timely thrombectomy can improve patency of hemodialysis arteriovenous fistulas
- Source :
- Journal of vascular surgery. 67(4)
- Publication Year :
- 2017
-
Abstract
- The urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis.A before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution. Data about thrombectomy procedures, performed within 1 year before and after the initiative was introduced, were abstracted from an electronic database. Immediate outcomes and patency outcomes were compared between the preinitiative (control) and postinitiative (intervention) groups.During the study period, 329 patients were enrolled, including 165 cases before and 164 cases after the initiative. The intervention group had more thrombectomy procedures performed within 24 hours (93% vs 55%; P .01) and within 48 hours (97% vs 79%; P .01) than the control group. No between-group differences in procedural success or clinical success rates were found. At 3 months, the intervention group had a higher postintervention primary patency rate than the control group, although this did not reach statistical significance (58% vs 48%; P = .06). After stratification into native or graft accesses, the patency benefit was observed in the native access group (68% vs 50%; P = .03) but not in the graft access group (50% vs 46%; P = .65). After adjusting for potential confounders, timely thrombectomy remained an independent predictor of postintervention primary patency (hazard ratio, 0.449; 95% confidence interval, 0.224-0.900; P = .02) for native dialysis accesses.Our results suggest that a timely thrombectomy approach, in which salvage is attempted within 24 hours of thrombosis diagnosis, improves postintervention primary patency of native but not graft accesses for dialysis.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Databases, Factual
medicine.medical_treatment
030232 urology & nephrology
Salvage therapy
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Time-to-Treatment
03 medical and health sciences
Blood Vessel Prosthesis Implantation
0302 clinical medicine
Arteriovenous Shunt, Surgical
Renal Dialysis
Risk Factors
medicine
Vascular Patency
Humans
Dialysis
Aged
Proportional Hazards Models
Quality Indicators, Health Care
Retrospective Studies
Thrombectomy
Aged, 80 and over
Salvage Therapy
Chi-Square Distribution
business.industry
Hazard ratio
Graft Occlusion, Vascular
Retrospective cohort study
Thrombosis
Middle Aged
medicine.disease
Quality Improvement
Surgery
Treatment Outcome
Multivariate Analysis
Female
Hemodialysis
Cardiology and Cardiovascular Medicine
business
Chi-squared distribution
Program Evaluation
Subjects
Details
- ISSN :
- 10976809
- Volume :
- 67
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....a58c00dc0d92ba43cc08fad55dfa6a8b