Objective: To compare between surgical revision with adjunctive balloon angioplasty on intragraft stenosis (intervention group) and surgical revision alone (control group) in post-intervention primary patency rate, the efficacy of balloon angioplasty on intragraft stenosis and incidence of intragraft stenosis in thrombosed dialysis graft.

Material and Method: Between March 2016 and January 2017, All thrombosed dialysis graft patients at Ramathibodi Hospital were analyzed (n = 104). Grafts created less than 3 months or more than 2 years, a graft with infection, contrast allergy, and surgical revision more than twice were excluded. Forty-two patients were enrolled and randomly assigned to control and intervention group. All patients underwent surgical revision and intraoperative fistulography. Adjunctive balloon angioplasty was performed in the intervention group if intragraft stenosis with 50% or greater luminal narrowing was detected. Patency rates were estimated by Kaplan-Meier survival analysis.

Results: The two groups exhibited similar demographic features and comorbidities (p>0.05). A median follow-up time is 124 days (95% CI 126 to 291). No significant difference in overall post-intervention primary patency rate between the two groups (p = 0.973), at 3-month follow-up of control group [75% (95% CI 0.57 to 0.86)] and intervention group [78% (95% CI 0.61 to 0.88)]. And at 6-month follow-up of control group [62% (95% CI 0.43 to 0.76)] and intervention group [58% (95% CI 0.38 to 0.73)]. In subgroup analysis of patients who had intragraft stenosis, the post-intervention primary patency rate of the intervention group was higher than in the control group (p = 0.009). At 3-month follow-up of control group [62% (95% CI 0.23 to 0.86)] and intervention group [87% (95% CI 0.38 to 0.98)]. And at 6-month follow-up of the control group [0%] and the intervention group [31% (95% CI 0.04 to 0.64)]. Anatomic success rate after balloon angioplasty was 100%. The incidence of intragraft stenosis was 28.5% (12/42).

Conclusions: Incidence of intragraft stenosis was 28.5% and could be effectively corrected by balloon angioplasty, therefore resulting in prolonged vascular access function.

Keywords: Thrombosed grafts, Prosthetic arteriovenous graft, Thrombosed prosthetic hemodialysis grafts, Balloon angioplasty, Intragraft stenosis