The Delay of Recanalisation of Acutely Thrombosed Dialysis Arteriovenous Access Until the Next Workday has No Negative Impact on Clinical Outcome

• DOI: 10.1007/s00270-024-03897-5
• Publication Date: 2024-11-18T21:50:12Z
• Authors: Konstantin Hellwig; Stefan Zicha; Christoph Kopp; Ulrich Rother; Nikolaos Papatheo...; Michael Uder; Axel Schmid
• Keywords: 03 medical and health sciences; 0302 clinical medicine

Abstract

Purpose The necessity of providing endovascular recanalization of acutely thrombosed arteriovenous access (AV access) during weekend is questionable, since hemodialysis can alternatively be achieved by temporarily placed non-tunneled central venous catheters (CVC). Interventional therapy of acutely thrombosed AV access is provided only on weekdays in the study center. This study aimed to compare outcomes in patients admitted on weekdays and on the weekend.

Methods A total of 355 endovascular procedures for thrombosed AV access performed in a single tertiary center from 2007 to 2017 were retrospectively analyzed for technical and clinical success, complications, rate of CVC and length of hospitalization. Technical success was defined as adequate blood flow with less than 30% residual stenosis, clinical success was defined as at least one successful hemodialysis after recanalization. There were two groups: patients who had to wait at least 2 days for recanalization due to admission at the weekend (n = 59, at-the-weekend group, ATW group) and patients receiving therapy no later than the day after admission (n = 296, on a working day group, OAW group).

Results The technical/clinical success rate was 96.6%/88.1% in the ATW and 89.1%/84.6% in the OAW group (p > .05). Complications did not differ among groups (p > .05). Despite a higher rate of CVC, no attributed additional adverse events or complications were observed in the ATW group (p > .05).

Conclusion Despite a longer time until treatment and a higher rate of short-term CVC, it seems to be justified to provide recanalization of dialysis shunts only during weekdays.

Graphical Abstract