BALLOON ANGIOPLASTY WITH CLOT LYSIS AS A FIRST LINE MEASURE FOR SALVAGE OF THROMBOSED ARTERIO-VENOUS ACCESS (AVA)

C WILKINSON1, M MANTHA1, S DHEDA1
1Cairns Base Hospital (Queensland Health), Cairns, Australia

Aim: To assess long-term outcome of thrombolysis plus balloon angioplasty of thrombosed fistulae.
Background: A thrombosed AVA often necessitates an emergent central catheter to facilitate immediate haemodialysis and then surgical intervention. Most thrombosis is due to significant stenosis limiting flow.  Early intervention may salvage the AVA.  We reviewed the immediate success and long-term outcomes of these interventions.
Methods: We present a retrospective observational study of the rates of percutaneous angioplasty of thrombosed AVAs from our health service since 2010.   Initial success was defined as on table return of flow. Ongoing patency was defined as effective dialysis at 3, 6 and 12 months in the absence of further intervention.   Data collected from the medical records included date of fistula creation, percutaneous and surgical interventions prior and following the thrombolysis events.
Results: 30 patients received 43 thrombolysis/angioplasty episodes.  The mean time to first thrombosis was 4.8 years with a prior mean 4.6 angioplasty procedures/ patient. All AVA were in the upper limbs; 80% were fistulae and 20% were grafts.  Cause of thrombosis was stenosis in 93% of the episodes.  Mean time to lysis was 1.6 days with 95% performed in outpatient setting.  The initial success rate was 97%.  15 episodes (35%) required central line access within the first week following procedure. AVA patency was 44% at 3 months, 36% at 6 months and 20% at 12 months.  By 12 months, 25% of AVAs had subsequent angioplasty and were functional, 10 patients required formation of new AVA; and 3 patients were dialysing via a permacath.
Conclusion: Following AVA thrombosis, percutaneous intervention avoided emergent central catheter insertion in 65% of patients, surgical intervention was avoided in 57% of patients.


Biography:
Dr Catherine Wilkinson is a advanced trainee in nephrology, currently based at Cairns Hospital.

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