Impact of residual anastomotic thrombus during surgical thrombectomy and endovascular intervention for arteriovenous graft thrombosis

Abstract

Objective:

To evaluate the clinical impact of residual thrombus at the anastomotic site during surgical thrombectomy and endovascular intervention for arteriovenous graft (AVG) thrombosis.

Methods:

This retrospective, single-center cohort study reviewed 203 consecutive cases of vascular access thrombosis treated between January 2015 and December 2023. Among them, 43 cases of AVG thrombosis with a first-time occlusion and successful revascularization were included for analysis. A per-protocol analysis focusing on postintervention outcomes was conducted among patients who underwent surgical thrombectomy and/or endovascular intervention. Residual anastomotic thrombus was assessed on intraoperative final angiography. All cases were divided into those with residual anastomotic thrombus and those without. The primary outcome measure was postintervention assisted primary patency (PAPP). In addition, hazard ratios of each variable for postintervention patency were evaluated using univariate and multivariate analysis.

Results:

All 43 patients were divided into two groups: 12 patients (27.9%) with residual anastomotic thrombus and 31 patients (72.1%) without residual anastomotic thrombus. During a median follow-up period of 19 months, PAPP was significantly lower in cases with residual anastomotic thrombus than those without (residual thrombus: 38.1% at 90 days, 19.1% at 180 days, and 19.1% at 365 days; non-residual thrombus: 93.2% at 90 days, 85.7% at 180 days, and 74.6% at 365 days; log-rank p < 0.0001). There was no significant difference in postintervention secondary patency between cases with residual anastomotic thrombus and those without (residual thrombus: 75.0% at 90 days, 65.6% at 180 days, and 65.6% at 365 days; non-residual thrombus: 96.8% at 90 days, 96.8% at 180 days, and 93.1% at 365 days; log-rank p = 0.148). Multivariate analysis identified residual thrombus as an independent risk factor for PAPP (hazard ratio 5.57; 95% confidence interval 2.40–12.93; p < 0.0001), as well as variables including endovascular intervention.

Conclusion:

AVG thrombosis with residual thrombus at the anastomotic site during intervention showed significantly lower PAPP than those without. Residual anastomotic thrombus may be a relevant factor associated with patency outcomes, and further prospective evaluation is warranted to assess its utility as a treatment endpoint of intervention for AVG thrombosis.