COMPARATIVE EFFICACY OF PULSE-SPRAY THROMBOLYSIS AND ANGIOPLASTY VERSUS SURGICAL SALVAGE PROCEDURES FOR TREATMENT OF RECURRENT OCCLUSION OFPTFE DIALYSIS ACCESS GRAFTS

Purpose: To compare the efficacy of surgery versus pulse-spray thrombo lysis and angioplasty in patients with recurrent thrombosis of polytet rafluoroethylene (PTFE) dialysis access grafts. Methods: We analyzed 9 6 consecutive interventions for thrombosed PTFE dialysis access grafts in 18 patients. Primary patency after thrombolysis and angioplasty (n = 25) was compared with primary patency following thrombectomy alone (n = 50) or thrombectomy followed by graft revision (n = 21) using Lif e-table analysis. A Cox proportional hazards model that accounted for graft age and number of previous interventions was used to generate th e relative risk for recurrent occlusion following therapy. Results: Li fe-table analysis showed that patency after thrombolysis and angioplas ty was greater than that following thrombectomy alone (p = 0.02). Afte r accounting for the age of the graft and the number of previous inter ventions (average six per patient), the relative risk for recurrent oc clusion [3.0; 95% confidence intervals (CT): 1.5, 6.4] was greater for thrombectomy alone than for thrombolysis/angioplasty [0.6; CI = 0.3, 1.3]. The relative risks of repeat occlusion following thrombolysis/an gioplasty [0.6; CI = 0.3, 1.3] and thrombectomy/surgical revision [1.0 ; CI = 0.5, 1.7] were similar. Conclusion: Outcome data from our retro spective study on recurrent thrombosis of PTFE dialysis access grafts suggest that thrombolysis/angioplasty is superior to thrombectomy alon e, and equivalent to lthrombectomy/surgical revision.