Description

ABSTRACT

Arterio-venous fistulas can occasionally develop thrombosis requiring endo-vascular thrombolysis. As an alternative to expensive balloon angioplasty, we have been using an improvised technique, which includes ultrasound-guided instillation of thrombolytic agents through multiple punctures, followed by thrombo-aspiration and maceration.

Objectives: To study the immediate clinical success, patency rates at 3 and 6 months and complications following an improvised endo-vascular technique for the treatment of thrombosed native Arterio-Venous fistulas.

Methods: A retrospective observational study was done on 25 patients with thrombosed Arterio-Venous fistulas who underwent this improvised endo-vascular technique in Pushpagiri Medical College Hospital from 1st January 2018 to 30th June 2020 and all relevant data were collected. The outcome variables included immediate clinical success, primary and secondary patency rates and complications related to the procedure. A Kaplan-Meier analysis was done for patency rates at 3 and 6 months.

Results: Immediate clinical success of this technique was 17 (68%). The primary and secondary patency rates at three months were 15 (60%) and 13 (40%) respectively. Complications included bleeding from puncture site and systemic bleeding in 1 (4%) patient each.

Conclusion: This affordable endo-vascular thrombolytic technique, which eliminates the need of balloon angioplasty, has shown reasonable success in restoring and maintaining fistula patency, and thus turns out to be a promising alternative in a resource-limited setting.

Key words: Improvised Endo-vascular Thrombolytic Technique, Primary patency rate, Secondary patency rate, Thrombosed Arterio-Venous Fistulas