Surgical versus endovascular intervention for vascular access thrombosis: a nationwide observational cohort study

There is no consensus whether an arterio-venous (AV) access thrombosis is best treated by surgical or endovascular intervention. We compared the influence of surgical versus endovascular intervention for AV access thrombosis on access survival using real-life data from a national access registry. We included patients from the Swedish Renal Access Registry (SRR-Access), with a working AV access undergoing surgical or endovascular intervention for their first thrombosis 2008- 2020. Primary outcome was risk of access abandonment, (secondary patency at 30, 60, 90, 365 days). Secondary outcomes were time to next intervention and 30-day mortality. Access characteristics were obtained from SRR-Access, patient characteristics were collected from the Swedish Renal Registry (SRR). Outcomes were assessed with multivariable logistic regression, and cox proportional hazard regression models adjusted for demographics, clinical, and access-related variables. 904 patients with AV access thrombosis (54% AVF, 35% upper arm access) were included, mean age 62 years, 60% women, 75% had hypertension, and 33% diabetes. Secondary patency was superior after endovascular intervention; 85% versus surgical 77% (30 days); 76% versus 69% (90 days). The adjusted odds of access abandonment within 90 days and one year was higher in the surgical thrombectomy group, (Odds Ratio 1.44 (95% confidence interval 1.05-1.97 and OR 1.25 (0.94-1.66) respectively). Results were consistent in long-term analysis. There was no significant difference in time to next intervention or mortality, results were consistent within subgroups. Endovascular intervention was associated with a small short-term and long-term benefit as compared to open surgery in hemodialysis patients with AV access thrombosis.