Non-surgical salvage of thrombosed arterio-venous fistulae: a case series and review of the literature.

Attempts to salvage thrombosed hemodialysis arterio-venous fistulae (AVF) using interventional techniques are not universally performed. Patients often require temporary dialysis catheters pending creation of a new vascular access. We determined the long-term outcome of interventional (non-surgical) repair of completely thrombosed AVF in 49 consecutive accesses (22 radio-cephalic, 1 radio-basilic, 19 brachio-cephalic, and 7 brachio-basilic) referred for an intervention within 48 hours of thrombosis. Subjects were 65% male (32), with mean +/- SD age 63.7 +/- 13.5 years (range 33-91), 51% African-American (25), 47% Caucasian (23) and 65% had diabetes (32). Overall, 96% (47/49) of thrombosed AVF were salvaged with complications observed in four cases (two extravasations of contrast; two radial artery emboli), with no serious long-term sequelae. Interventional procedures included 34 venous angioplasties, 11 venous angioplasties with stenting and two combined venous and arterial angioplasties. The primary and secondary patency rates for all salvaged AVF were 50.5 +/- 8.7%, 72.5 +/- 7.8% at 1 year, and 43.3 +/- 10%, 55.4 +/- 12.7% at 2 years, respectively. The median estimate to first intervention after the declot procedure was 14.7 months. The median estimate for continued function exceeded 23.1 months. There was no significant statistical difference in the primary (p = 0.73) and secondary patency rates (p = 0.057) for forearm vs. upper arm AVF. We conclude that interventional repairs should routinely be employed to salvage newly thrombosed AVF. The vast majority of these individuals can avoid receiving dialysis catheters or placement of a new dialysis vascular access.