Patency and Life-Spans of Failing Hemodialysis Grafts in Patients Undergoing Repeated Percutaneous De-Clotting

We set out to determine retrospectively the primary and secondary patency rates, as well as the life-spans, of failing polytetrafluoroethylene dialysis grafts after repeated percutaneous mechanical de-clotting. The study group consisted of all patients who had undergone percutaneous mechanical de-clotting, balloon angioplasty, or angiography of their polytetrafluoroethylene hemodialysis grafts at our institution from 1 January through 30 April 1999. Patency of the hemodialysis grafts was calculated using Kaplan-Meier analysis. A total of 161 percutaneous de-clotting procedures were performed on 59 of 71 patients. At 1 year, the primary and secondary surgical patency rates of the grafts were 29% and 61.4%, respectively. The life-spans of the polytetrafluoroethylene grafts after repeated percutaneous de-clotting and surgical interventions was 93.5% at 6 months, 78% at 1 year, 58.8% at 2 years, and 35% at 3 years. The patency rates after the 1st, 2nd, and 3rd de-clotting procedures were 55.9%, 61.9%, and 55.8% at 3 months and 32.2%, 40.8%, and 31.4% at 6 months, respectively (P=0.40). The patency rate of grafts after mechanical de-clotting using the Arrow-Trerotola thrombectomy device was not statistically different from that of the crossed angioplasty balloon technique alone (P=0.38). Further, there was no difference in the life-spans of grafts whether they were located in the upper or lower extremity. Because reocclusion rates are similar following 1st, 2nd, and 3rd occlusions, regardless of the percutaneous mechanical de-clotting technique used, repeated percutaneous management should be undertaken to preserve each graft regardless of the number of previous de-clotting procedures. (Tex Heart Inst J 2001;28:249–53)