Outcomes of Catheter-Directed Thrombolysis for Arteriovenous Fistula Thrombosis in Singapore: Is It Still Relevant Today?

Objective: To review the outcomes of catheter-directed thrombolysis (CDT) for salvage of thrombosed arteriovenous fistula (AVF) in a single centre in Southeast Asia. Methods: A retrospective study of CDT in AVF between January 2015 and July 2018 at a tertiary university hospital was carried out. Results: Within the study period, 85 patients underwent CDT for AVF thrombosis. Of these patients, 78% underwent CDT for 24 h and 12% required CDT for 48 h. Moreover, 14% of patients had bleeding during CDT and hence required a decrease in dosing or complete cessation. Incidence of intracranial haemorrhage was 1%, and technical success was 92%. Post CDT, primary patency rates at 12, 24 and 36 months were 87%, 62% and 36%, respectively; assisted primary patency rates at 12, 24 and 36 months were 96%, 82% and 69%, respectively; and secondary patency rates at 12, 24 and 36 months were 99%, 93% and 86%, respectively. Multivariate analysis did not identify any predictive factors for patency post CDT. Conclusion: Within our study population, CDT for AVF salvage conferred good technical results with low rates of complications. There was good primary patency at 12 months, and the results were sustained up to 36 months. It remains a useful modality for fistula salvage, avoiding surgical intervention.