A venotomy and manual propulsion technique to treat native arteriovenous fistulas occluded by thrombi

Abstract

Objective : The objective of our study was to evaluate the efficacy and safety of a venotomy and manual propulsion technique that is performed to treat failed native arteriovenous fistulas (AVFs) with chronic organized thrombi.

Materials and Method : For this study, we retrospectively reviewed a total of 69 venotomy and manual propulsion procedures performed from October 2005 to July 2009 in 56 patients for the treatment of native AVFs occluded by chronic thrombi. Inflow, anastomotic, and outflow veins were occluded using balloon catheters. Venotomy was made in the thrombi-bearing vein, and thrombi were propelled toward the venotomy site in a "milking" manner and were removed. After repair of the venotomy using simple interrupted sutures, the occlusion balloons were deflated. Angioplasty of the underlying stenosis was performed.

Results : Technical success was achieved in 95.7% of the procedures and clinical success was achieved in 91.3%. The follow-up duration was 1-50 months (mean, 16.7 months), with 3-, 6-, and 12-month primary patency rates of 92.5%, 80.8%, and 58.1%, respectively, and secondary patency rates of 98.1%, 96.2%, and 91.7%. The complication rate was 7.24%, with two major and three minor complications.

Conclusion : The venotomy and manual propulsion technique is effective and safe for the removal of chronic and organized thrombi from occluded native AVFs.