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Dialysis arteriovenous (AV) access is the Achilles Heel for dialysis patients. However, almost two-thirds of the accesses develop thrombosis. A timely salvage procedure preserves the vascular treasure for future access creation and avoids dialysis catheter dependency. We aimed to assess the success rate of endovascular salvage of thrombosed AV access.
This retrospective study at a tertiary teaching hospital included all the endovascular salvage of thrombosed AV access performed by a trained interventional nephrologist between June 2021 and October 2023. Surgically salvaged AV access and dialysis catheters were excluded.
During the study period of 29 months, 45 salvage procedures were attempted. There were 29 (64.44%) males and 16 (35.56%) females, and the average age of the patients was 52.6 years (SD = 12.68 years, Range 23-80 years). Most of the AV access was in the left upper limb, i.e., 80% (n = 36), of which 46.67% (n = 21) were radiocephalic AV fistula (AVF) followed by brachiocephalic AVF 37.78% (n = 17), brachiobasilic AVF 8.89% (n = 4), brachioaxillary AV graft 4.44% (n = 2) and one snuff box AVF.
Depending on the availability of thrombolytic, Reteplase was used in almost half of the patients, i.e., 46.67% (n = 21), followed by Urokinase 22.22% (n = 10) and Alteplase 11.11% (n = 5). Interestingly, in one-fifth of the patients, i.e., nine patients, no thrombolytic was used, and plain balloon maceration of the clot was done.
84.44% (n = 38) of procedures were successful; these were used for dialysis for at least one session.
Endovascular salvage of the arteriovenous access has a reasonable success rate and should be attempted before abandoning the access. However, the long-term patency needs to be assessed in prospective studies