Objective To explore the feasibility, safety and efficacy of modified pharmacomechanical endovascular thrombolysis for chronic thrombosis of arteriovenous graft (AVG).
Methods Between January 1, 2020 and December 31, 2022, retrospective analysis was performed for 81 patients on endovascular treatment for AVG thrombosis for more than 3 days. Based upon the duration of thrombosis formation, they were assigned into two groups of 3-7 d (n=66) and >7 d (n=15). Demographic profiles, fistula characteristics, thrombotic features, success rate of intracavitary treatment, incidence of complications and patency rate after pathway intervention were compared.
Results Average thrombotic time was 4(3, 5) day in 3-7 d group and 14(10, 23) day in >7 d group. The success rate of intracavitary treatment was 98.77%(80/81) in both groups and clinical success rate 98.77%(80/81) without any serious complication. Technical success rate was 98.48%(65/66) in 3-7 d group and 100%(15/15) in >7 d group. Clinical success rate was 98.48%(65/66) in 3-7 d group and 100%(15/15) in >7 d group. There was no statistically significant inter-group difference. After a total follow-up period of 1 year, primary patency rates at Day 30/90/180/270/360 post-intervention were 89.39%(59/66), 69.70%(46/66), 50.00%(22/66), 33.33%(22/66) and 21.21%(12/66) in 3-7 d group and 86.67% (13/15), 80.00%(12/15), 46.67%(7/15), 26.67%(4/15) and 20.00%(3/15) in >7 d group. Both groups maintained decent 1-year cumulative patency rates. It was 78.79% in 3-7 d group and 80.00% in >7 d group. There was no significant inter-group statistical difference.
Conclusions Modified pharmacomechanical endovascular thrombolysis is feasible, effective and safe for chronic AVG thrombosis. Capable of prolonging usage time of AVG, it is worthy of wider clinical promotions.
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