FP653OUTCOMES ENDOVASCULAR SALVAGE OF CLOTTED ARTERIOVENOUS ACCESSES AND PREDICTORS OF POSTINTERVENTION PATENCY

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INTRODUCTION: Arterio-venous (AV) access thrombosis remains a major morbidity for patient receiving maintenance hemodialysis for end stage renal disease.Clotted AV accesses can be salvage via open surgery or endovascular technique. We aim to report the outcome of endovascular salvage of clotted AV accesses in our centre and determine potential predictors of patency rates following intervention. METHODS: Records of hemodialysis patients who underwent endovascular salvage of clotted arteriovenous access were reviewed retrospectively. Anatomic and clinical success rates, complication rates and 3- and 6-month patency rates were determined. Multivariate analysis was performed to determine the predictors of patency following intervention. RESULTS: A total of 294 patients underwent endovascular salvage of clotted AV access during the study period. Majority of the patients had accesses situated in the upper arm (72.1%) with 53.1% being arteriovenous fistulas (AVF) and while the remaining 46.9% were arteriovenous grafts (AVG). The median age of the AV access was 2.5 (IQR 9.3, 55.1) months. Of all the patients studied, 194 (66.0%) had at least one previous intervention to their accesses, and 42 (14.3%) had a prior episode of thrombosis within 90 days for which the access was successfully salvaged previously. The anatomical and clinical success rates were 96.3% and 93.2% while the major and minor complications rates were 0.7% and 9.9%. Postintervention primary, assisted primary and secondary patency rates were 61.6% and 63.7% and 83.8% at 3-months and 34.9%, 40.1% and 65.6% at 6-month. The patency rates of AVF were significantly longer than AVG except for 6-month secondary patency. Multivariate Cox-regression analysis showed that thrombosis within 90 days was significantly and negatively associated with primary (HR:1.887; 95% CI:1.265–2.817, p<0.01), assisted-primary (HR: 2.032; 95% CI:1.274–3.241, p<0.01) and secondary patency rates (HR: 2.110, 95% CI:1.147–3.881, p=0.02). Having an AVG was also negatively associated with primary (HR:1.440, 95% CI: 1.067-1.945, p=0.02) and assisted primary patency (HR:1.463, 95% CI 1.042-2.054, p=0.03) while access age was the only significant protective predictor (HR: 0.993, 95% CI 0.988-0.998, p=0.01 and HR 0.993, 95% 0.987-0.999, p=0.01) of primary and assisted primary patency. CONCLUSIONS: Majority of clotted AV accesses can be salvaged via endovascular technique. Recurrent thrombosis within 90 days is associated with poor short and long-term patency even after successful endovascular re-interventions. AV accesses that thrombosed within short-interval following intervention should be carefully evaluated prior to repeat endovascular interventions

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