Timely thrombectomy can improve patency of hemodialysis arteriovenous fistulas |
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Authors: | Mu-Yang Hsieh Lin Lin Tsung-Yan Chen Dao-Ming Chen Ming-Hsien Lee Yung-Fang Shen Chung-Wei Yang Shao-Yuan Chuang Chih-Cheng Wu Kuan-Yu Hung |
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Affiliation: | 1. Cardiovascular Center, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan;2. College of Medicine, National Taiwan University, Taipei, Taiwan;3. Department of Nursing, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan;4. Division of Nephrology, Department of Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan;5. Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan;6. Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan |
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Abstract: | ObjectiveThe urgency with which salvage of thrombosed vascular accesses for dialysis should be attempted remains unknown. We examined the effect of a timely thrombectomy approach on vascular access outcomes for dialysis.MethodsA before-and-after study was conducted with patients on hemodialysis who had undergone endovascular thrombectomy. A timely thrombectomy initiative (ie, salvage within 24 hours of thrombosis diagnosis) was started in July 2015 at our institution. Data about thrombectomy procedures, performed within 1 year before and after the initiative was introduced, were abstracted from an electronic database. Immediate outcomes and patency outcomes were compared between the preinitiative (control) and postinitiative (intervention) groups.ResultsDuring the study period, 329 patients were enrolled, including 165 cases before and 164 cases after the initiative. The intervention group had more thrombectomy procedures performed within 24 hours (93% vs 55%; P < .01) and within 48 hours (97% vs 79%; P < .01) than the control group. No between-group differences in procedural success or clinical success rates were found. At 3 months, the intervention group had a higher postintervention primary patency rate than the control group, although this did not reach statistical significance (58% vs 48%; P = .06). After stratification into native or graft accesses, the patency benefit was observed in the native access group (68% vs 50%; P = .03) but not in the graft access group (50% vs 46%; P = .65). After adjusting for potential confounders, timely thrombectomy remained an independent predictor of postintervention primary patency (hazard ratio, 0.449; 95% confidence interval, 0.224-0.900; P = .02) for native dialysis accesses.ConclusionsOur results suggest that a timely thrombectomy approach, in which salvage is attempted within 24 hours of thrombosis diagnosis, improves postintervention primary patency of native but not graft accesses for dialysis. |
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Keywords: | Correspondence: Chih-Cheng Wu MD Cardiovascular Center National Taiwan University Hospital Hsinchu Branch No 25 Ln 442 Sec 1 Jingguo Rd Hsinchu Taiwan |
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