Abraham Korn1, Hamid Alipour1, Joshua Zane1, Ali Shahverdiani1, Timothy J Ryan1, Amy Kaji2, Nina Bowens3, Christian de Virgilio4. 1. Department of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA. 2. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA. 3. Department of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA. 4. Department of Surgery, Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA. Electronic address: cdevirgilio@labiomed.org.
Abstract
BACKGROUND: Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence and identify factors associated with early thrombosis of AVF and to determine salvage rates following thrombosis, at a high-volume hemodialysis access center. METHODS: Retrospective review of autologous AVF was created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery. RESULTS: There were 291 AVFs. The median age was 54.7 years, and 192 patients (66%) were male. Early postoperative AVF thrombosis was noted in 5 (1.7%) cases. Factors associated with early thrombosis on univariate analysis included previous access surgery (P = 0.02) and absence of a good intraoperative thrill (P = 0.006). Intraoperative protamine use trended toward significance (P = 0.06). Factors that were not significant included gender, diabetes, dialysis at time of surgery, fistula configuration, and systemic heparin use. None of the thrombosed fistulas were salvaged. CONCLUSIONS: Early thrombosis is a relatively rare complication of AVF creation at a high-volume center. Previous access surgery and absence of good thrill at conclusion of the procedure are associated with early thrombosis.
BACKGROUND:Arteriovenous fistulas (AVF) are the preferred modality for hemodialysis access. Early thrombosis hampers development of a working AVF. We endeavored to determine the incidence and identify factors associated with early thrombosis of AVF and to determine salvage rates following thrombosis, at a high-volume hemodialysis access center. METHODS: Retrospective review of autologous AVF was created between November 2014 and July 2016 at a single center. Early thrombosis was defined as thrombosis that occurred within 30 days of surgery. RESULTS: There were 291 AVFs. The median age was 54.7 years, and 192 patients (66%) were male. Early postoperative AVF thrombosis was noted in 5 (1.7%) cases. Factors associated with early thrombosis on univariate analysis included previous access surgery (P = 0.02) and absence of a good intraoperative thrill (P = 0.006). Intraoperative protamine use trended toward significance (P = 0.06). Factors that were not significant included gender, diabetes, dialysis at time of surgery, fistula configuration, and systemic heparin use. None of the thrombosed fistulas were salvaged. CONCLUSIONS: Early thrombosis is a relatively rare complication of AVF creation at a high-volume center. Previous access surgery and absence of good thrill at conclusion of the procedure are associated with early thrombosis.
Authors: Laisel Martinez; Mikael Perla; Marwan Tabbara; Juan C Duque; Miguel G Rojas; Nieves Santos Falcon; Simone Pereira-Simon; Loay H Salman; Roberto I Vazquez-Padron Journal: Kidney360 Date: 2022-01-13
Authors: Peter C Thomson; Patrick B Mark; Michele Robertson; Claire White; Stefan D Anker; Sunil Bhandari; Kenneth Farrington; Alan G Jardine; Philip A Kalra; John McMurray; Donal Reddan; David C Wheeler; Christopher G Winearls; Ian Ford; Iain C Macdougall Journal: Kidney Int Rep Date: 2022-05-18