Outcomes of thrombosed arteriovenous grafts: comparison of stents vs angioplasty

Kidney International
Ivan D Maya, Michael Allon

Abstract

The usual radiologic approach to thrombosed grafts is a combination of thrombectomy and angioplasty of the underlying lesion. However, the primary (unassisted) graft patency after thrombectomy is quite poor. We evaluated whether graft patency following thrombectomy is improved by placement of a stent in the stenotic lesion. Using a prospective, computerized vascular access database, we identified 14 patients with thrombosed arteriovenous (A-V) grafts treated with a stent at the venous anastomosis (stent group). The outcomes of these grafts was compared to those observed in 34 sex, age-, and date-matched control patients whose thrombosed A-V grafts were angioplastied (control group). Both groups were comparable in age, sex, race, diabetic status, graft age, and number of previous graft interventions. The immediate technical success, as indicated by the post-procedure graft to systemic pressure ratio, was similar in the stent and control groups (0.33+/-0.16 vs 0.41+/-0.17, P=0.14). The primary graft patency (time from thrombectomy to next intervention) was significantly longer for the stent group (median survival, 85 vs 27 days, P=0.02). Assisted or secondary patency (time from thrombectomy to permanent graft failure) was also lo...Continue Reading

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