Endovascular salvage of thrombosed haemodialysis vascular access.

Background: Haemodialysis access thrombosis is associated with significant morbidity and access abandonment rates, for which endovascular salvage is a well described treatment option. This study aimed to evaluate the outcomes of endovascular salvage procedures of thrombosed vascular access circuits and identify factors influencing outcomes. Patients and methods: Retrospective review of 328 consecutive procedures performed over 10 years at our institution between January 2010 and December 2019. Patient demographics, access circuit characteristics, procedure details and outcome data were collected. Kaplan-Meier survival curves were used to estimate patency rates and Cox multivariate regression analysis to identify factors affecting outcomes. Results: Technical and clinical success rates were 87.8% and 75.9% respectively. The primary, primary assisted and secondary patency rates at 6 months were 42.2%, 46.7% and 59.1%; and at 12 months were 23.4%, 28.3% and 41.8% respectively. Median access circuit survival was 9.2 months. Major complication rate was 5.2% including 3 procedure-related deaths. Native AVF, lower time from thrombosis to intervention and pharmacomechanical thrombectomy using AngioJetTM predicted positive outcomes. Previous thrombectomy within 3 months and residual thrombus at completion were associated with poorer outcomes. Age and hypertension predicted higher complication rates. Conclusions: This is one of the largest single center series of endovascular salvage of thrombosed haemodialysis access and demonstrates that endovascular treatment is effective and provides durable access circuit survival. Careful patient screening is essential to optimize outcomes.

Percutaneous Venous Reconstruction for Central Thrombosis-Associated Chylothorax: A Safe and Efficacious Option.

Central thrombosis-associated chylothorax is underrecognized in children and frequently refractory to conservative management. Central venous catheterizations are the predominate cause. We present 3 cases highlighting endovascular techniques used to treat persistent chylous effusions. (Level of Difficulty: Advanced.).

Safety and Efficacy of Sodium Tetradecyl Sulfate and Lipiodol Foam in Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) for Large Porto-Systemic Shunts.

OBJECTIVE: To evaluate the safety and efficacy sodium tetradecyl sulfate and lipiodol foam (STS foam) in BRTO for large (caliber ≥15 mm) porto-systemic shunt and gastric fundal varices. MATERIALS AND METHODS: It is a retrospective record-based study of patients who underwent BRTO using STS foam at the Institute of Liver and Biliary Sciences, New Delhi, for gastric variceal bleed or refractory hepatic encephalopathy (HE) who had large porto-systemic shunt (diameter ≥15 mm) with or without associated gastric varices. Clinical and laboratory parameters were evaluated before and after the procedure. All patients were followed for minimum of 12 months. RESULTS: Records of 22 patients were analyzed. Technical success was achieved in 22 of 22 sessions. Complete obliteration of shunt with clinical improvement was seen in 20 of 22 cases. Patients with gastric varices had no residual gastric varices on follow-up endoscopy. There were significant reduction in CTP scores and improvement in HE grades following BRTO. Post-procedure complication was encountered in 6 patients (5 minor and 1 major), and 7 patients showed worsening of esophageal varices and underwent endoscopic variceal ligation. One patient had succumbed to septicemia at a follow-up of 34 months. CONCLUSION: Our experience suggests STS foam is a safe and effective agent for patients with large shunt undergoing BRTO.