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The urgency of salvage attempts on thrombosed vascular access for dialysis remains unknown. Only data from observational studies are available. We examined the effect of a timely thrombectomy approach on the outcome of vascular access for dialysis.
A retrospective before-and-after study was conducted with patients who had undergone endovascular thrombectomy. A timely thrombectomy initiative, namely salvage within 24 hours after diagnosis, was started from July 2015 in our institution. Data of thrombectomy procedures within one year before and one year after the initiative were abstracted from an prospectively-followed electronic database. The immediate and patency outcomes before and after the initiative were compared.
During the study period, 329 patients were enrolled, including 165 patients before and 164 patients after the quality-improvement initiative. The after-initiative group had fewer late thrombectomies than the before-initiative group (7.3% vs. 45.5%, p<0.01). No difference in technical success rate or clinical success rate was observed. At three months, 154 out of the 329 patients had experienced recurrent access dysfunction (primary patency rate, 53.2%). The after-initiative group had higher primary patency rate than the before-initiative group (52.1% vs. 41.5%, P=0.06). After stratification into native or graft accesses, the difference of patency rate was only observed in the native access group (after vs. before: 68% vs. 50%, P=0.03) but not in the graft access group (after vs. before: 50% vs. 46%, P=0.68). After adjustment for potential confounders, a timely thrombectomy initiative remained an independent predictor of patency failure for native accesses.
Our results suggest that a timely thrombectomy approach within 24 hours is effective in improving patency rate of native accesses for dialysis, but not for graft accesses.