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

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.