Introduction
Arteriovenous fistulas (AVFs) are the preferred choice for long-term hemodialysis because of their low rates of complications and associated costs compared with other forms of accesses. One of these complications is the susceptibility to stenoses and subsequent thrombotic occlusion. The aim of this study is to establish a valid classification for thrombosed AVFs based on their thrombus load and to describe different procedures for AVF salvage based on this classification.
Patients and methods
In this prospective study, 90 patients with failed AV access were enrolled in this study and divided into three groups based on the thrombus load within the vein of the AV access based on clinical and ultrasonographic assessment. The diameter of the thrombosed vein was measured and accordingly the three groups were divided into: Group A: minimal thrombus load (diameter less than 6 mm). Group B: moderate thrombus load (diameter more than 6 mm and less than 12 mm or the presence of one aneurysm within the vein with a diameter less than 2 cm). Group C: high thrombus load (diameter: more than 12 mm or the presence of more than one aneurysm within the vein or the presence of any aneurysm >2 cm in diameter). Patients were subjected to angioplasty with or without thrombectomy according to their classification and were monitored for functional outcome and patency rates.
Results
The success rate was 95.1% in group A, 90.9% in group B, and 87.5% in group C. Over a period of 1, 3, and 6 months postoperatively, the primary patency rates were 94.8%, 91.5%, and 89.2% in group A, 89.3%, 87.0%, and 84.2 in group B, and 85.7%, 81.9%, and 75% in group C, respectively.
Conclusion
Thrombosed AVFs are amenable for salvage whatever their thrombus load. There is no statistical difference in the patency of salvaged AVFs with variable thrombus load among the three groups.