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E1878. Salvaging Thrombosed Upper Extremity Hemodialysis Arteriovenous Accesses with Stent Grafts
Authors
  1. Jiwon Youm; Santa Clara Valley Medical Center
  2. Robert Burky; Santa Clara Valley Medical Center
  3. Stephen Hugdal; Santa Clara Valley Medical Center
  4. Jeffrey Sung; Santa Clara Valley Medical Center
Objective:
The purpose of this study is to compare the patency rates of thrombosed hemodialysis arteriovenous prosthetic grafts (AVGs) and native fistulas (AVFs) following declot procedures with concomitant stent graft placement. Furthermore, as salvage of dialysis accesses with stent grafts is often performed due to re-thrombosis following a declot with angioplasty alone, we sought to assess the impact of a recent declot procedure on patency rates.

Materials and Methods:
A retrospective review of declot procedures with stent graft placement between May 2017 and June 2019 at our institution was performed. Primary and secondary (access re-thrombosis) patency rates for AVFs were compared to those of AVGs using Kaplan-Meier survival estimates and log-rank tests. Patency rates for AVGs that had a recent declot procedure within the 30 days preceding the declot with stent graft placement were compared in similar fashion with those that did not. AVFs were excluded from this subgroup analysis as none within our study had a declot within the prior 30 days.

Results:
34 declot procedures were performed with stent graft placement for thrombosed dialysis accesses (25 AVGs and 9 AVFs) during the study period. Primary patency rates at 30, 60 and 90 days (from stent graft placement) were 89%, 89%, and 78%, respectively, for AVFs and 54%, 38%, and 23%, respectively, for AVGs (log-rank test P = 0.017). Secondary patency rates were 100% through 90 days for AVFs and 73%, 65% and 58% at 30, 60, and 90 days, respectively, for AVGs (log-rank test P = 0.002). Nine AVGs had a recent declot. Primary patency rates at 30, 60 and 90 days were 56%, 33%, and 22%, respectively, compared to 56%, 44%, and 25%, respectively, for AVGs without recent declot (log-rank test P = 0.765). Secondary patency rates at 30, 60 and 90 days were 56%, 44%, and 44%, respectively, compared to 88%, 81%, and 69%, respectively, for AVGs without recent declot (log-rank test P = 0.412).

Conclusion:
Stent graft deployment can salvage thrombosed hemodialysis AVFs and AVGs. However, sustained patency occurs more frequently with AVFs than with AVGs. Additionally, recent thrombosis in an AVG does not does preclude a repeat declot procedure with stent graft placement.