Comparative Efficacy of Endovascular Versus Surgical Thrombectomy for Arteriovenous Graft Thrombosis in Hemodialysis Patients - A Systematic Review and Meta-Analysis
Thomas Jatiman1*, Ni Kadek Sulistyaningsih1, Danang Himawan Limanto1
Journal of Angiotherapy 8(12) 1-8 https://doi.org/10.25163/angiotherapy.81210120
Submitted: 09 November 2024 Revised: 21 December 2024 Published: 21 December 2024
Abstract
Background: End-stage kidney disease (ESKD) is a significant public health issue, necessitating hemodialysis as a primary renal replacement therapy. The long-term success of hemodialysis depends on maintaining functional vascular access, with arteriovenous grafts (AVGs) being widely utilized. Thrombosis remains a major complication leading to access failure, necessitating prompt and effective intervention. This systematic review and meta-analysis compare the efficacy of endovascular and surgical thrombectomy in managing thrombosed AVGs. Methods: A systematic search was conducted in Cochrane Library, EMBASE, and PubMed for studies published between 2015 and 2023. Studies comparing endovascular and surgical thrombectomy in hemodialysis patients were included. Statistical analyses were performed using Review Manager software, applying random-effects models where heterogeneity was significant (I² > 50%). The primary outcomes assessed were technical failure, primary non-patency at one year, and secondary non-patency at one year. Results: Six retrospective cohort studies involving 1,520 participants were included. The analysis revealed no statistically significant difference in one-year primary non-patency between endovascular and surgical thrombectomy (OR: 0.58, 95% CI: 0.20–1.62, p = 0.29). Similarly, one-year secondary non-patency rates showed no significant difference (OR: 0.86, 95% CI: 0.64–1.16, p = 0.32). Technical failure rates were comparable between the two interventions. While surgical thrombectomy has traditionally been favored, recent advancements in endovascular techniques have led to equivalent patency outcomes. Conclusion: Endovascular and surgical thrombectomy demonstrate comparable efficacy in managing thrombosed AVGs in hemodialysis patients. Given the minimally invasive nature and technological advancements of endovascular techniques, they may offer a viable alternative to surgical thrombectomy. Further randomized controlled trials are needed to refine treatment strategies and optimize vascular access management.
Keywords: End-stage kidney disease, Hemodialysis vascular access, Arteriovenous graft thrombosis, Endovascular thrombectomy, Surgical thrombectomy
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