Comparison of minimally invasive thrombectomy with percutaneous balloon angioplasty for organized thrombi in hemodialysis access

Background: Thrombi are an important challenge when establishing hemodialysis access for hemodialysis. We developed a minimally invasive thrombectomy (MIT) salvage treatment to solve this problem when traditional percutaneous transluminal angioplasty (PTA) fails. Objectives: The study aimed to investigate the safety and patency rate following MIT as a rescue procedure for traditional PTA with organized thrombi obstructing hemodialysis access. Methods: This was a prospective study of MIT as a rescue procedure for traditional PTA to remove organized thrombi and establish hemodialysis access. We included patients with (1) stenotic lesions, (2) vascular access thrombi, (3) high venous pressure, (4) vascular collapse and suction. Nephrologists evaluated hemodialysis access immediately post-thrombi removal and patency at 7, 30, 60, 120, and 180 days post-removal, in addition to complications. Kaplan-Meier survival analysis was performed to analyze the primary and secondary patency rates after clinical procedural success. Results: From June 2014 to May 2015, 746 patients underwent PTA in our hospital, and 425 patients consented to participate in this study. Of these patients, we enrolled 46 who underwent simultaneous PTA and MIT. Immediate clinical success was achieved in 100% of the patients in the MIT group. No complications were observed in any of the 46 patients, including major bleeding, shock, or hospitalization. The primary and secondary patency rates did not differ between MIT and PTA alone (p = 0.93 and p = 0.28, respectively). Conclusions: MIT can be considered a safe rescue procedure for removing organized thrombi to establish vascular access for hemodialysis when initial and traditional PTA fails.