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CC BY 4.0 · The Arab Journal of Interventional Radiology 2025; 09(01): 042-047
DOI: 10.1055/s-0044-1795086
Original Article

Rheolytic Pharmacomechanical Thrombectomy in Renal Dialysis Arteriovenous Fistula and Graft Thrombosis: Outcomes from a Tertiary Hospital in Qatar

Ahmad L. F. Yasin 
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Sohaib Zoghoul 
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Ahmad N. Al-Ekeer
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Yaman M. Alahmad 
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Ali Barah
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Saad Rehman
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Omran Almokdad 
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Qayed Al-Debyani
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Ayman Elmagdoub
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
,
Rahil Hussein Kassamali 
1   Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
2   Aston Medical School, Aston University, Birmingham, United Kingdom
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Abstract

Purpose To investigate the ability to salvage an acutely thrombosed dialysis access using rheolytic pharmacomechanical thrombectomy (PMT), the short- and medium-term patency rates and safety at a tertiary care hospital.

Methods A retrospective review of all patients who underwent rheolytic PMT for a thrombosed arteriovenous fistula (AVF) or arteriovenous graft (AVG) from October 2020 to 2023 was performed. Primary patency was defined as the ability to successfully dialyze through the treated access site without further intervention. Secondary patency included patients who required additional interventions that enabled them to continue dialysis. Data analysis was conducted using SPSS for comprehensive statistical evaluation.

Results A total of 37 thrombectomy procedures, involving 15 AVF and 22 AVG cases, were performed on 31 patients; 20 males and 11 females with a mean age of 62 ± 13 years. The average time from recognizing dialysis access site dysfunction to intervention was 2.6 ± 1.4 days. The mean total rheolytic PMT run time was 295 ± 119 seconds. Immediate technical success was defined as restoration of flow between the arteriovenous anastomosis and the central veins. Technical success was achieved in 91.9% (34/37) of thrombectomies. Clinical success was defined as the ability to achieve successful dialysis within 48 hours of the intervention. In total, 72.9% (27/37) of these cases achieved clinical success. Primary patency rates at 1, 3, and 6 months were 87.5, 78, and 46.9%, respectively. Secondary patency rates at 3, 6, and 12 months were 87.5, 66.7, and 58.3%, respectively. Angioplasty was performed in all procedures, and stent insertion was required in 13.5% (5/37) of thrombectomies.

Conclusion This study adds to the evidence that rheolytic PMT is a safe and effective tool for AVF and AVG salvage. After an initial thrombosis, the chance of re-thrombosis within 12 to 24 months is high and teams looking after these patients should have a strategy for future dialysis access.

Keywords

arteriovenous fistula - arteriovenous graft - thrombectomy


Publication History

Article published online:
20 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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