Effectiveness of two different surgical methods for treatment of acute thrombosis in arterio-venous fistula

Objective To investigate the surgical effectiveness of arteriovenous fistula thrombectomy and reconstruction and percutaneous transluminal angioplasty(PTA)for the treatment of acute thrombosis in arterio-venous fistulas(AVFs)in the forearm in hemodialysis patients.Methods The clinical data of 117 hemodialysis patients with acute thrombosis in arterio-venous fistula,who were admitted to Aviation General Hospital during the period from January 2014 to June 2018,were retrospectively analyzed.Among 117 patients,55 cases were treated with fistula reconstruction surgery,62 cases were treated with PTA.Demographic data,surgical success rates and post-operative complication incidence,between the two surgical methods were compared. The primary patency and secondary patency rates were evaluated by Kaplan-Meier analysis.Results There were no significant differences between the two groups in the average age of patients,the average service life of internal fistula,and the thrombosis time(P>0.05).Of 55 cases subject to fistula reconstruction surgery,the surgical success rate was 96.3% and the clinical success rate was 90.9%;at 3,6 and 12 months after operation,the primary patency rate was 98.2%,92.7% and 87.3%,and the secondary patency rate was 100.0%,98.2% and 92.7%,respectively.In a total of 62 cases of PTA,success rate of operative anatomy was 91.9%,and clinical success rate was 88.7%;at 3,6 and 12 months after operation,primary patency rate was 93.5%,83.9% and 72.5% respectively,and secondary patency rate was 100%,98.4% and 93.5% respectively.There were no procedure-related major complications.Conclusions In comparison to PTA,fistula reconstruction surgery for treatment of AVF thrombosis has a high success rate and a low relapse rate,prolongs survival time,and is an effective method to treat arterio-venous fistula thrombosis.