Comparison of balloon thrombectomy without thrombolytic agents with hybrid surgery in treating arteriovenous graft thrombosis

Abstract

Objective:

To compare modified balloon thrombectomy (BT) without thrombolytic agents versus hybrid surgery for arteriovenous graft thrombosis in hemodialysis patients.

Design:

Single-center retrospective comparative study.

Methods:

Thrombosed AVGs underwent thrombectomy between July 2016 and January 2024 were divided into BT and hybrid groups. Thrombosis events were categorized as first and recurrent thrombosis subgroups. Primary and primary-assisted patency rates were assessed using Kaplan-Meier analysis, and prognostic factors were identified via multivariate Cox regression.

Results:

We analyzed 158 patients with 304 AVG thrombotic events. Primary patency rates at 6 and 12 months were 41.7% and 20.3% for 161 BTs versus 41.1% and 13.8% for 134 hybrid procedures (p = 0.51). In the first AVG thrombosis subgroup (73 BTs and 69 hybrids), primary patency rates were 39.3% and 14.7% for BTs versus 51.7% and 23.6% for hybrids (p = 0.096). For recurrent thrombosis, primary patency rates at 6 and 12 months were 43.6% and 24.6% for 88 BTs versus 30.5% and 4.8% for 65 hybrids (p = 0.007). Multivariate Cox regression analysis revealed that the number of prior interventions (hazard ratios (HR) = 1.14, 95.0% confidence interval (CI) 1.05–1.23, p = 0.002) and age of AVG (HR = 0.77, 95.0% CI 0.66–0.89, p < 0.001) significantly influenced the primary patency of recurrent thrombosis.

Conclusion:

BT is a safe and effective intervention for thrombosed AVGs, particularly for patients with recurrent thrombosis. The number of prior interventions and age of AVGs primarily influenced patency rates in recurrent thrombosis cases.