Comparison between open and pharmacomechanical repair of acutely thrombosed arteriovenous hemodialysis fistulae within a decade

Journal article


Publication Details

Author(s): Regus S, Almási-Sperling V, Rother U, Meyer A, Schmid A, Uder M, Lang W
Journal: Hemodialysis International
Publication year: 2018
Volume: 22
Journal issue: 4
Pages range: 445-453
ISSN: 1492-7535


Abstract

INTRODUCTION: Different declotting techniques are available for acutely thrombosed arteriovenous hemodialysis fistulae (AVF). The aim of this single-center study was to compare immediate and follow-up results between surgical repair and a modified interventional lyse-and-wait technique characterized by prolonged local reaction times of recombinant tissue-plasminogen activator (rtPA).
MATERIALS AND METHODS: We retrospectively analyzed medical records of 110 consecutively treated patients between the years 2003 and 2013. All patients were on hemodialysis (HD) and suffered from an acutely thrombosed AVF. The treatment standards changed in the course of time, wherefore we compared 2 groups: the open repair (OR) (N = 50) and the endovascular repair (ER) group (N = 60).
FINDINGS: We found no significant differences in success rates (OR 92%/ER 96.7%; P = 0.28), immediate failures (IFs) (OR 8%/ER 10%; P = 0.71), and temporary catheter placements (TCPs) (OR 10%/ER 6.7%; P = 0.52). Furthermore, there were no differences in cumulative primary patency rates (P = 0.42) and secondary patency rates (P = 0.97).The infection rate was significantly increased after OR (8%) compared to ER (0%); P = 0.026. The hospital stay in days was shorter after ER (5.2 ±2.8) vs. OR (9.0 ± 3.5); P < 0.001.
CONCLUSION: The modified lyse-and-wait technique with prolonged local reaction times is a successful alternative to surgical repair for acutely thrombosed AVF. Clear benefits are less infections and significant shorter hospital stays after ER. However, OR remains the preferred treatment for aneurysms and anastomotic stenoses.


FAU Authors / FAU Editors

Almási-Sperling, Veronika
Medizinische Fakultät
Lang, Werner apl. Prof. Dr.
Gefäßchirurgische Abteilung
Regus, Susanne PD Dr.
Gefäßchirurgische Abteilung
Rother, Ulrich Dr. med.
Professur für Plastische Chirurgie und Handchirurgie
Schmid, Axel PD Dr.
Radiologisches Institut
Uder, Michael Prof. Dr.
Lehrstuhl für Diagnostische Radiologie


How to cite

APA:
Regus, S., Almási-Sperling, V., Rother, U., Meyer, A., Schmid, A., Uder, M., & Lang, W. (2018). Comparison between open and pharmacomechanical repair of acutely thrombosed arteriovenous hemodialysis fistulae within a decade. Hemodialysis International, 22(4), 445-453. https://dx.doi.org/10.1111/hdi.12660

MLA:
Regus, Susanne, et al. "Comparison between open and pharmacomechanical repair of acutely thrombosed arteriovenous hemodialysis fistulae within a decade." Hemodialysis International 22.4 (2018): 445-453.

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Last updated on 2019-14-03 at 10:38