The Impact of Needle-Directed Thrombolysis in Thrombosed Arteriovenous Fistulas on Angioplasty Efficacy and the Prognostic Factors Associated with Success.

Abstract

Purpose: Urokinase thrombolysis is a feasible method for salvage of thrombosed arteriovenous fistulas (AVFs). The impact of optimizing thrombolysis outcomes on improving the efficacy of subsequent angioplasty remains unclear. This study is aimed to investigate the impact of thrombolysis outcomes and to identify the prognostic factors of thrombolysis.

Patients and methods: The patients were divided into a complete lysis (CL) group of 336 treatments, an incomplete lysis (IL) group of 83 treatments, and a lysis failure (LF) group of 206 treatments. The efficacy data of the subsequent angioplasty and the patency before the next intervention were compared. Demographics, fistula characteristics, and baseline serum parameters were compared to screen for prognostic factors of thrombolysis outcomes.

Results: As the degree of thrombolytic therapy decreased, the complication rate significantly increased (CL, 14.6%; IL, 21.7%; LF, 30.6%; trend P < 0.001), whereas the clinical success rate of angioplasty decreased (CL, 97.0%; IL, 94.0%; LF, 82.3%; trend P < 0.001). However, no difference was noted in the patency interval before the next intervention among the three groups (log-rank P = 0.562). Elbow AVF and hemoglobin < 115 g/L were risk factors of poor lysis outcomes. The complete lysis rate of patients with both factors was 24.2%, whereas the rates of patients with one or neither factor were significantly higher (all > 50% and P = 0.001).

Conclusion: Complete thrombolysis is beneficial for improving the efficacy of recanalization procedures for thrombosed AVFs. Non-elbow AVFs and hemoglobin ≥115 g/L are predictors of an increased complete lysis rate.