Balloon-assisted thrombolysis in native vascular access thrombosis treatment

Native arteriovenous fistula (AVF) remains the gold standard for permanent vascular access in hemo­dialysis patients with end-stage renal disease (ESRD). However, AVF thrombosis is a common and serious complication that leads to access loss and increases the risk of infections and mortality due to the need for central venous access implantation. This highlights the necessity for effective and safety treatment methods. Endovascular techniques, particularly balloon-assisted thrombolysis, represent a promising approach to this problem.

Objective: To evaluate the immediate and long-term outcomes of balloon-assisted thrombolysis in patients with thrombosed native AVF.

Materials and methods: A retrospective analysis was performed on data from 34 ESRD patients who underwent endovascular treatment for native AVF thrombosis between 2020 and 2023 was conducted. Patency rates were assessed using the Kaplan-Meier method. Statistical analysis included calculation of median primary and primary-assisted patency with 95% confidence intervals (CI).

Results: The overall primary patency was 11.5 (95% CI [5.19, 8.48]) months. Forearm AVFs demonstrated superior primary patency at 13.0 months (95% CI [5.38, 10.53]) compared with 11.0 months (95% CI [4.08, 8.79]) for upper arm AVFs. The technical success rate was 97%. Primary-assisted patency at 6, 10, and 12 months was 97%, 64%, and 50%, respectively. By 12-month, all upper arm AVFs had lost patency, whereas only 21% of forearm AVFs had thrombosed (p<0.001). Intraoperative complications included venous perforation (15%) with complete resolution of residual thrombi (32%), with complete resolution of residual thrombi by the 4th week of follow-up. No major complications, such as pulmonary embolism or distal arterial embolism, were recorded.

Conclusions: Balloon-assisted thrombolysis is a highly effective and safe method for restoring patency in thrombosed native AVFs, achieving a high technical success rate. Forearm access location is an important prognostic factor and is associated with significantly better long-term primary-assisted patency outcomes compared with upper arm fistulas.

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