Tratamiento de la trombosis de los injertos de PTFE para hemodiálisis mediante trombectomía percutánea. Estudio prospectivo

Summary Objective . Nowadays, the guidelines (DOQI) recommend a three months patency rate of 40% for percutaneous thrombectomy of thrombosed dialysis AV grafts. Our study purpose is to evaluate the efficacy of mechanical thrombectomy for treatment of this dialysis AV grafts complication. Patients and methods . 107 percutaneous thrombectomies of PTFE thrombosed dialysis AV grafts performed in 75 patients were prospectively analyzed, using hydrodynamic technique (Hydrolyser®) in the 35 first cases (33%) and simple mechanical technique with an angioplasty balloon in the last 72 ones (67%). Underlying lesions were evaluated with fistulography and angioplasty was done when required. Anatomic success, clinical success, underlying lesions, initial thrombosis (72 hours), patency and complications were analyzed. Results . Anatomic success was obtained in 103 cases (96.2%) and clinical success in 101 cases (94.4%). The initial thrombosis rate was 17.3%. Underlying stenosis were detected in 68 grafts (90.6%), and were successfully treated with PTA. Primary patency was 50%, 39% and 30% and secondary patency was 62%, 49% and 40% at 3, 6 and 12 months. Major complications occurred in 2 cases (1.86%). Time elapsed after the thrombotic episode (1.6 days) (p= 0.01) and the hydrodinamic technique (p= 0.0026) result in a lower patency rate. Conclusions . Mechanical thrombectomy is safe and effective for the treatment of the thrombosed PTFE hemodialysis AV graft. The DOQI recommendations for treatment of this graft complication are fulfilled with this technique.