{
  "abstract": "Purpose: To compare single session (SS) versus extended infusion (EI) catheter-directed thrombolysis (CDT) combined with PTA for acute AVG thrombosis, with allocation based on thrombus burden and lesion morphology.\n\nMethods: This study included hemodialysis patients with acute AVG thrombosis treated between April 2020 and September 2023. All patients underwent angiographic classification of AVG stenosis/occlusion into two morphological types: Type I (isolated venous anastomotic stenosis/occlusion) and Type II (complex, multi-segment occlusion involving the arterial anastomosis, graft lumen, and/or venous anastomosis). Based on this classification and thrombus burden assessment, patients with Type I lesions or low thrombus burden received SS-CDT + PTA, while those with Type II lesions or high thrombus burden received EI-CDT + PTA. The primary endpoint was primary patency. Secondary endpoints included technical success rate, procedure-related complications, and secondary patency. Kaplan–Meier survival analysis and multivariate Cox proportional hazards regression were performed. A shared-frailty model and patient-level sensitivity analysis were used to account for within-patient clustering.\n\nResults: A total of 105 procedures in 89 patients were analyzed (SS-CDT, n = 73; EI-CDT, n = 32). Median primary patency was comparable: SS-CDT 183 days vs. EI-CDT 183 days (log-rank p = 0.867). The proportion of Type II lesions was 80.8% (59/73) in the SS-CDT group and 90.6% (29/32) in the EI-CDT group ( p = 0.261). On multivariate Cox regression, graft age >24 months was associated with improved patency (HR 0.59, p = 0.023), while Type II morphology (HR 0.80, p = 0.428) and CDT protocol (HR 0.91, p = 0.79). Technical success was 100% in both groups (excluding 7 crossover procedures). One major complication (septic shock) occurred in the EI-CDT group. Minor complications were comparable, except puncture-site bleeding (EI-CDT: 18.8% vs. SS-CDT: 0%, p < 0.001). Urokinase infusion was interrupted in 2 EI-CDT procedures due to bleeding.\n\nConclusions: Patency outcomes were not significantly influenced by CDT protocol duration or lesion morphology, suggesting that the stratified treatment approach effectively equalized outcomes across clinical contexts; notably, graft age >24 months was independently associated with improved primary patency (HR 0.59, p = 0.023), a finding most plausibly reflecting survivor-graft bias rather than a true treatment effect.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Interventional Radiology, Hui Ya Hospital of The First Affiliated Hospital of Sun Yat-Sen University , ,",
    "Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Bin Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "Keyu Tang"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaoyuan Lin"
    },
    {
      "affs": [
        1
      ],
      "name": "Guiyuan Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Run Lin"
    },
    {
      "affs": [
        1
      ],
      "name": "Haitao Dai"
    },
    {
      "affs": [
        1
      ],
      "name": "Yonghui Huang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/czjr6esdxd0f9.bib",
  "cited_by": 0,
  "doi": "10.3389/fcvm.2026.1919383",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672488/?tool=EBI",
  "id": "czjr6esdxd0f9",
  "issns": [
    "2297-055X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13672488",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3604|Central Venous Catheters and Hemodialysis"
    ]
  ],
  "openalex": "W7216427728",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672488/pdf/?tool=EBI",
  "pmcid": "PMC13672488",
  "pmid": null,
  "published": "2026-10-02",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/czjr6esdxd0f9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:18Z",
      "native_id": "PMC:PMC13672488",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13672488"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "10.3389/fcvm.2026.1919383",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fcvm.2026.1919383/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2297-055X",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Thrombus burden-stratified catheter-directed thrombolysis combined with percutaneous transluminal angioplasty for acute arteriovenous graft thrombosis in hemodialysis patients: a comparison of single-session versus extended infusion protocols",
  "title_text": "Thrombus burden-stratified catheter-directed thrombolysis combined with percutaneous transluminal angioplasty for acute arteriovenous graft thrombosis in hemodialysis patients: a comparison of single-session versus extended infusion protocols",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/czjr6esdxd0f9",
  "venue": "Frontiers in cardiovascular medicine",
  "versions": []
}