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
- 1Department of Interventional Radiology, Hui Ya Hospital of The First Affiliated Hospital of Sun Yat-Sen University , ,
- 2Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University , ,
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.
Methods: 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.
Results: 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.
Conclusions: 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.
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BibTeX
@article{chen2026thrombus,
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}},
author = {Bin Chen and Keyu Tang and Xiaoyuan Lin and Guiyuan Zhang and Run Lin and Haitao Dai and Yonghui Huang},
journal = {Frontiers in cardiovascular medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1919383},
url = {https://europepmc.org/article/PMC/PMC13672488},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Bin Chen
AU - Keyu Tang
AU - Xiaoyuan Lin
AU - Guiyuan Zhang
AU - Run Lin
AU - Haitao Dai
AU - Yonghui Huang
PY - 2026
DA - 2026/10/02
JO - Frontiers in cardiovascular medicine
DO - 10.3389/fcvm.2026.1919383
UR - https://europepmc.org/article/PMC/PMC13672488
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2297-055X
ER -