Abstract: 【Abstract】Objective To investigate the efficacy of thrombus aspiration combined with percutaneous transluminal angioplasty (PTA) via percutaneous vascular sheath in the treatment of acute thromboembolism in autologous arteriovenous fistula (AVF). Methods Patients with acute thrombotic occlusion of AVF treated in the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University from March 2014 to July 2020 were selected as the research subjects. Their clinical data were recruited retrospectively. They were divided into thrombus aspiration group (thrombus aspiration combined with PTA) and local thrombolysis group (local thrombolysis combined with PTA). Surgical success rate, incidence of postoperative complications and primary patency rate after the treatment for one year were compared between the two groups. The patency rate was evaluated by Kaplan-Meier analysis. Results A total of 61 patients were enrolled in this study, including 28 cases in the thrombus aspiration group and 33 cases in the local thrombolysis group. The anatomical success rate and clinical success rate in the thrombus aspiration group were 100% and 96.4% respectively, higher than those of 96.9% and 90.9% respectively in the local thrombolysis group but without statistical significances (χ2=0.863 and 0.753, P=0.353 and 0.385). The incidence of postoperative complications
in the thrombus aspiration group (7.4%) was slightly higher than that in the local thrombolysis group (6.7%) but without statistical significance (χ2=0.029, P=0.865). The primary patency rates after the operation for 3, 6 and 12 months in the thrombus aspiration group were 96.3%, 92.6% and 74.1%, respectively, while those in the local thrombolysis group were 96.7%, 76.7% and 46.7%, respectively; the rates in the two groups were statistically significant (χ2=4.158, P=0.041). Conclusions Thrombus aspiration combined with PTA via percutaneous vascular sheath is a safe and effective method to treat acute thrombotic occlusion of AVF, especially for patients with contraindications of thrombolysis. This method can also prolong the survival time of AVF.

Key words: Thrombosis aspiration, Thrombolysis, Percutaneous transluminal angioplasty, Arteriovenous fistula occlusion