The role of vacuum-assisted mechanical thrombectomy in the management of acutely thrombosed arteriovenous fistulas and grafts

PURPOSE

The purpose of this study is to evaluate the safety and efficacy of the mechanical thrombectomy with the Indigo System in the treatment of thrombosed arteriovenous fistulas and grafts.

METHODS

A retrospective search of endovascular procedures performed from November 2018 to June 2020 was conducted. Inclusion criteria were: acute arteriovenous fistula or graft thrombosis that underwent endovascular mechanical thrombectomy with Indigo System. The following information was collected from each case: sex, age, fistula modality, fistula location, treatment modality, and outcomes. Endpoints evaluated were: technical and clinical success rates; primary, assisted primary, and secondary patency rates; complication rates.

RESULTS

Twenty-six mechanical thrombectomy procedures for declotting of arteriovenous fistula thrombosis, using the Indigo System, were performed in 22 patients. Technical and clinical success was achieved in 23/26 cases (88%). Mean follow-up was 9 months (range 11-539 days). The 6-month primary, primary assisted, and secondary patency rates were 71%, 86%, 93% and the 12-month primary, primary assisted, and secondary patency rates were 71%, 72%, 80%, respectively. No technical or device-related complications were observed during thrombectomy, however two venous ruptures occurred on the angioplasty of the underlying stenosis.

CONCLUSION

In conclusion, vacuum-assisted thrombectomy of acutely thrombosed arteriovenous fistulas and grafts with Indigo System is safe and effective, providing good short term patency rates.

Spirituality correlates positively with higher quality of life and negatively with depression in a sample of low income brazilian cancer patients

18534

Background: Brazil has a multicultural mostly poor population with many different kinds of religious affiliations. Since cultural, psychological, spiritual and social factors may influence the quality of life (QOL) of cancer patients, we wanted to evaluate spirituality and its relation to depression and the QOL in a sanple of these patients. Methods: We surveyed 72 adult cancer patients through three questionnaires: a general one, the FACIT-Sp QOL questionnaire, as well as the Beck depression inventory, all of them already validated in Portuguese. From the FACIT-Sp questionnaire we obtained also the general quality of life (FACT-G) score. We evaluated correlations between variables with Chisquare, Fisher and ANOVA tests. Since multiple univariate correlations were assessed in this study, we considered significant only p values equal or bellow 0.005. We employed multiple regression analysis to evaluate if depression and spirituality would independently correlate with QOL. Results: We included 72 patients. The mean age was 52 years, 63.9% were female, 58.3% were married, 20.8% were regularly employed, and 59.7% had studied up to elementary school only. For most patients (66, 2%) their religious faith was the most important factor that helped them to cope with their disease. We found no statistical correlations between the scores of the questionnaire FACIT-Sp and any of the demographic variables. We observed significant correlations between higher scores of spirituality (ANOVA p < 0.001) with the absence of depression. Likewise higher scores of QOL (ANOVA p < 0.001) correlated with lack of depression. By multiple regression analysis both the spirituality dominion of the FACIT-Sp and the Beck depression inventory score correlated independently and significantly with general QOL measured by the FACT-G questionnaire’s score (p = 0.025 and p = 0.004, respectively). Conclusions: Despite the small sample size of our study, it was possible to show that religion is highly regarded by our patients and that it may influence their quality of life independently from depression. Furthermore, spirituality may also be a protective factor against depression. Therefore, physicians respect and encourage their religious practices.

No significant financial relationships to disclose.