CLINICAL OUTCOMES OF PERCUTANEOUS THROMBECTOMY OF DIALYSIS ACCESS THROMBOSIS BY NEPHROLOGISTS IN CENTRAL AUSTRALIA

C SAJIV¹, P BASANT¹, T SAJAN¹, N SAJITH¹, G PRATISH¹, J JACOB¹, H MARK², FD KIRAN¹.

1Alice Springs Hospital, Alice Springs, Northern Territory; 2Royal Darwin Hospital, Darwin, Northern territory

Aim: Thrombosed dialysis accesses are traditionally managed by interventional radiologists and vascular surgeons. The aim of the study was to evaluate outcomes of percutaneous thrombectomy performed by nephrologists in Central Australia.

Background: Central Australia is home to nearly 375 patients on hemodialysis. Interventional radiology services in Alice Springs Hospital are limited to fly in and fly out radiologist. The closest interventional radiology service is a distance of 1500 kms. Thrombosed A-V accesses prior to 2011 were predominantly managed by surgeons. The establishment of an interventional nephrology service since then has enabled percutaneous treatment of thrombosed vascular access along with routine fistulograms, fistuloplasties and stent insertions.

Methods: There were 17 thrombectomies done in 16 patients between February 2011 and April 2017. Majority i.e.., 16/17 thrombectomies were performed in the radiology suite. Thrombectomy was performed by thromboaspiration and pharmacomechanical thrombolysis. One patient required a hybrid procedure with surgical declotting followed by fistuloplasty. This is a descriptive analysis of the demographics of the vascular access requiring intervention and the outcomes.

Results: The average age of patients was 56.6 years, majority 14/16 (87.5%) were diabetics, most of the AV fistulas (AVF) requiring intervention were brachiocephalic (75%), only 1 was a graft. The overall success rate was 81.25%. The fistulas which underwent successful thrombectomy remained functional for an average of 70.5 weeks following the procedure (0-119). Two patients died with functional fistulas. There was one complication that included vascular rupture which was managed by balloon tamponade and stent insertion.

Conclusion: This preliminary analysis of percutaneous thrombectomies performed by nephrologists is encouraging.  This data needs comparison with surgical thrombectomy and endovascular techniques done elsewhere in Australia and around the world.    

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