FISTULA THROMBOSIS IN A REGIONAL QUEENSLAND CENTRE
Dr MIKE WU1,2, Dr TAKUMA KONNO2, ALLAN WONG2, Dr OH SUNG CHOY2, Dr VICTORIA WHITE2, Dr RAMESH VELU1,2, Dr YEW TOH WONG1,2, Dr VIKAS SRIVASTAVAS2
1James Cook University, Townsville, Australia, 2Townsville University Hospital, Townsville, Australia
Background: Haemodialysis patients rely on their arteriovenous fistula (AVF) but there is no agreed-upon surveillance method to prevent thrombosis. In a regional area, performing routine imaging would be difficult due to resource limitations and access barriers.
Aim: To investigate the incidence of AVF thrombosis in patients in the Townsville region where they are managed without routine universal ultrasound surveillance.
Methods: All patients on dialysis who had a functional AVF were identified between Jan 1, 2020 and May 1, 2024. Their charts were reviewed and the following data collected: date of AVF creation, date of AVF thrombosis, date of AVF revision and operative details. Patients were placed into two groups for analysis: AVF with vein only, and AVF with graft inserted primarily or during revision surgery. Mann-Whitney U was used to test the difference in follow-up between the two groups.
Results: There were 212 patients with an AVF. There were 198 vein-AVF’s, and 14 graft-AVF’s. Between 2020 and 2024, there were 619.0 AVF-years of patency in the vein-AVF group with median follow-up of 3.83 years vs 45.8 years of patency in the graft-AVF group with median follow-up of 0.601 years (p<0.0001). There were 16 episodes of thrombosis in the vein-AVF group vs 9 in the graft-AVF group. Of the graft-AVF group, one patient experienced 4 episodes of thrombosis, two patients experienced 2 and one patient experienced 1. Sixteen patients in the vein-AVF group experienced 1. The overall thrombosis rate was 2.58% per graft-year for vein-AVF vs 19.7% for graft-AVF.
Conclusions: Our rate of AVF thrombosis is acceptably low. Graft-AVF had a significantly shorter follow-up time and was associated with a higher thrombosis rate.