Combined Thromboaspiration Via Sheath And Percutaneous Transluminal Angioplasty For Occluded Hemodialysis Grafts:A Report Of 22 Cases Observed In A Single Center

Background: According to the domestic and overseas epidemiological data, it is predicted that the population of CKD is more than 100 million, and that of ESRD is more than 2 million throughout our country. With the achievement of the medical insurance system and the enforcement of the dialysis quality management practices in our state, more and more patients can receive hematodialysis. Vascular access is the “life-line” of these patients. AVG is an important mode of vascular access, and K/DOQI guidance recommends it as secondary choice with poor self-vein conditions. Even under the principle “fistula first”, numerous scholars also found out, through studying, that the benefits for the patients by AVG is not inferior to AVF in regard with the elder patients. However, the preliminary patency rate of AVG is unsatisfactory, and thus the just-passable patency rate becomes the key limiting factor for patients to use AVG as an option. Thrombosis is the major cause for its dysfunction. Plenty of therapies are available for occluded AVG, among which mini-invasive sugery to increase AVG long-period patency rate and has significant social value for improving patient’s life quality.Objective: To investigate the safety and effectiveness of combined t hromboaspiration via sheath and percutaneous transluminal angioplasty for occluded hemodialysis grafts.Methods: 20 patients(13women, 7 men; mean age, 61.1±11.2 years; mean graft age, 19.7±8.7 months; mean time of thrombosis, 4.6±5.2 days) with 22 episodes of hemodialysis graft thrombosis underwent combined thromboaspiration via sheath and percutaneous transluminal angioplasty from March 2015 to October 2015. A syringe is used to aspirated thrombosis via a sheath until no further thrombi could be aspirated, then angioplasty was performed to stenosis as required. Technical success rate, procedure time, blood loss, length of stay, complications and patency rate were analyzed.Results: Technical success was achieved in 21 of 22 procedures(95.5%). A complication occurred in 1 case as arterial emboli(4.8%). High pressure balloon was needed in 7 producers and none stent was placed. The average time of the intervention procedure was(81.0±12.2)minutes and the mean blood loss was(4.1±0.8)ml and the average length of stay was(5.1±1.3)days. Primary patency at 1, 3, and 6 months, respectively, was 90.9%, 82.4%, and 72.7%.Conclusions: Combined thromboaspiration via sheath and percutaneous transluminal angioplasty for occluded hemodialysis grafts is a safe and effective method.