Frontiers in cardiovascular medicine · 2026
Thrombus burden-stratified catheter-directed thrombolysis combined with percutaneous transluminal angioplasty for acute arteriovenous graft thrombosis in hemodialysis patients: a comparison of single-session versus extended infusion protocols.
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Chen Bin, Tang Keyu, Lin Xiaoyuan, Zhang Guiyuan, Lin Run, Dai Haitao, Huang Yonghui
Аннотация
PURPOSE: To compare single session (SS) versus extended infusion (EI) catheter-directed thrombolysis (CDT) combined with PTA for acute AVG thrombosis, with allocation based on thrombus burden and lesion morphology.
METHODS: This study included hemodialysis patients with acute AVG thrombosis treated between April 2020 and September 2023. All patients underwent angiographic classification of AVG stenosis/occlusion into two morphological types: Type I (isolated venous anastomotic stenosis/occlusion) and Type II (complex, multi-segment occlusion involving the arterial anastomosis, graft lumen, and/or venous anastomosis). Based on this classification and thrombus burden assessment, patients with Type I lesions or low thrombus burden received SS-CDT + PTA, while those with Type II lesions or high thrombus burden received EI-CDT + PTA. The primary endpoint was primary patency. Secondary endpoints included technical success rate, procedure-related complications, and secondary patency. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed. A shared-frailty model and patient-level sensitivity analysis were used to account for within-patient clustering.
RESULTS: A total of 105 procedures in 89 patients were analyzed (SS-CDT, n = 73; EI-CDT, n = 32). Median primary patency was comparable: SS-CDT 183 days vs. EI-CDT 183 days (log-rank p = 0.867). The proportion of Type II lesions was 80.8% (59/73) in the SS-CDT group and 90.6% (29/32) in the EI-CDT group (p = 0.261). On multivariate Cox regression, graft age >24 months was associated with improved patency (HR 0.59, p = 0.023), while Type II morphology (HR 0.80, p = 0.428) and CDT protocol (HR 0.91, p = 0.79). Technical success was 100% in both groups (excluding 7 crossover procedures). One major complication (septic shock) occurred in the EI-CDT group. Minor complications were comparable, except puncture-site bleeding (EI-CDT: 18.8% vs. SS-CDT: 0%, p < 0.001). Urokinase infusion was interrupted in 2 EI-CDT procedures due to bleeding.
CONCLUSIONS: Patency outcomes were not significantly influenced by CDT protocol duration or lesion morphology, suggesting that the stratified treatment approach effectively equalized outcomes across clinical contexts; notably, graft age >24 months was independently associated with improved primary patency (HR 0.59, p = 0.023), a finding most plausibly reflecting survivor-graft bias rather than a true treatment effect.
METHODS: This study included hemodialysis patients with acute AVG thrombosis treated between April 2020 and September 2023. All patients underwent angiographic classification of AVG stenosis/occlusion into two morphological types: Type I (isolated venous anastomotic stenosis/occlusion) and Type II (complex, multi-segment occlusion involving the arterial anastomosis, graft lumen, and/or venous anastomosis). Based on this classification and thrombus burden assessment, patients with Type I lesions or low thrombus burden received SS-CDT + PTA, while those with Type II lesions or high thrombus burden received EI-CDT + PTA. The primary endpoint was primary patency. Secondary endpoints included technical success rate, procedure-related complications, and secondary patency. Kaplan-Meier survival analysis and multivariate Cox proportional hazards regression were performed. A shared-frailty model and patient-level sensitivity analysis were used to account for within-patient clustering.
RESULTS: A total of 105 procedures in 89 patients were analyzed (SS-CDT, n = 73; EI-CDT, n = 32). Median primary patency was comparable: SS-CDT 183 days vs. EI-CDT 183 days (log-rank p = 0.867). The proportion of Type II lesions was 80.8% (59/73) in the SS-CDT group and 90.6% (29/32) in the EI-CDT group (p = 0.261). On multivariate Cox regression, graft age >24 months was associated with improved patency (HR 0.59, p = 0.023), while Type II morphology (HR 0.80, p = 0.428) and CDT protocol (HR 0.91, p = 0.79). Technical success was 100% in both groups (excluding 7 crossover procedures). One major complication (septic shock) occurred in the EI-CDT group. Minor complications were comparable, except puncture-site bleeding (EI-CDT: 18.8% vs. SS-CDT: 0%, p < 0.001). Urokinase infusion was interrupted in 2 EI-CDT procedures due to bleeding.
CONCLUSIONS: Patency outcomes were not significantly influenced by CDT protocol duration or lesion morphology, suggesting that the stratified treatment approach effectively equalized outcomes across clinical contexts; notably, graft age >24 months was independently associated with improved primary patency (HR 0.59, p = 0.023), a finding most plausibly reflecting survivor-graft bias rather than a true treatment effect.