Different Modalities for Management of Thrombosed Arteriovenous Fistula: Multicenter Experience

Mohamed, Mohamed Ismail; Allam, Ahmed Khairy; Fakhr, Mohamed Emam

doi:10.21608/asjs.2025.357697.1180

	Different Modalities for Management of Thrombosed Arteriovenous Fistula: Multicenter Experience
Ain Shams Journal of Surgery
Volume 18, Issue 2, April 2025, Page 93-103 PDF (641.01 K)
Document Type: Original Article
DOI: 10.21608/asjs.2025.357697.1180
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Authors
Mohamed Ismail Mohamed¹; Ahmed Khairy Allam²; Mohamed Emam Fakhr ¹
¹Department of vascular Surgery, Faculty of Medicine, Ain Shams University, Egypt
²Department of General Surgery, Faculty of Medicine, Benha University, Egypt
Abstract
Introduction: This study aims to report and evaluate different declotting modalities with their outcomes for salvage of thrombosed native dialysis access. Patients and methods: Between March 2023 to March 2024, 70 patients with first time thrombosed native arteriovenous fistula (AVF) were recruited, 27 radio-cephalic, 20 brachio-cephalic and 23 brachio-basilic AVFs were treated either surgically with thrombectomy or endovascularly using different endovascular declotting concepts. Patients had follow-up at 1 week, 1, 3 and 6 months postoperatively. Results: In our study 15.7% (n=11/70) were treated with open thrombectomy and 84.3% (59/70) were treated endovascularly using 5 different techniques. Techniques used were open surgical thrombectomy, balloon maceration, pulse spray thrombolysis, mechanical thrombectomy (Aspirex device), aspiration thrombectomy (Penumbra device) and rheolytic mechanical thrombectomy (Angiojet device). Clinical success achieved in each group was 72.7%, 70%, 69.2%, 100%, 100% and 90.9% respectively (p=0.175), with 6-month primary patency 72.7%, 60%, 69.2%, 75%, 77.8% and 86.4%, respectively (p=0.629). Conclusions: Surgical and endovascular intervention for thrombosed AVFs have comparable early clinical success and short-term primary and secondary patency rates.
Keywords
Thrombosed fistula; Native; Thrombectomy; Declotting access


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