ORIGINAL ARTICLE   

Chirurgia 2020 December;33(6):306-11

DOI: 10.23736/S0394-9508.19.05077-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

The role of surgical thrombectomy of recently created radiocephalic arteriovenous fistulas in access salvage

Walid M. GAMAL ✉, Abdrheem F. MOHAMED, Zeniab M. ASKARY

Department of Vascular and Endovascular Surgery, Qena University Hospital, Qena, Egypt

BACKGROUND: For maintenance of successful hemodialysis (HD), functional vascular access is required. Arteriovenous fistula (AVF) thrombosis accounts for 65-85% of permanent access loss. We aim in our work to determine the rate of salvage of newly created radiocephalic arteriovenous fistulas (RCAVFs) via surgical thrombectomy in high risk patients for access thrombosis.
METHODS: One arm clinical trial was performed in the Department of Vascular surgery of Qena University Hospital, from October 2018 to October 2019. Twenty-five patients were allocated in our study after signing an informed consent. Patients’ risk factors and operative details were determined and all were recorded. Surgical thrombectomies under local anesthesia were performed. Only thrombosed RCAVFs of maximum two weeks of creation were tried to be salvaged.
RESULTS: Twenty-five patients were enrolled in the study, 20 males (80%) and 5 females (20%). Eight patients were diabetic representing 32% of patients and patency after surgical thrombectomies of recently created RCAVFs was 72% immediately postoperative, 60% two months after the operation, 52% at 6 months after the operation while it was 40% at one year with poor significant surgical outcomes in diabetics as P value <0.05.
CONCLUSIONS: Surgical thrombectomy of recently created radiocephalic AVFS is an efficient method for fistula salvage that should be considered whenever possible and within the proper time.

KEY WORDS: Kidney failure, chronic; Arteriovenous fistula; Thrombosis; Thrombectomy