Costs and outcomes of endovascular treatment of thrombosed dialysis autogenous fistulae

array:21 ["pii" => "X2013251413052928" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2013.Feb.11725" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2013;33:470-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7846 "formatos" => array:3 [ "EPUB" => 282 "HTML" => 6707 "PDF" => 857 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699513052920" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2013.Feb.11725" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2013;33:470-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6663 "formatos" => array:3 [ "EPUB" => 280 "HTML" => 5678 "PDF" => 705 ] ] "es" => array:10 [ "idiomaDefecto" => true "titulo" => "Costos y resultados del tratamiento endovascular de las trombosis en las fístulas autólogas para hemodiálisis" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "470" "paginaFinal" => "477" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Costs and outcomes of endovascular treatment of thrombosed dialysis autogenous fistulae" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Coentrao" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Coentrao" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251413052928" "doi" => "10.3265/Nefrologia.pre2013.Feb.11725" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052928?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052920?idApp=UINPBA000064" "url" => "/02116995/0000003300000004/v0_201502091404/X0211699513052920/v0_201502091404/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X201325141305291X" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2013.Apr.11800" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2013;33:478-85" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5329 "formatos" => array:3 [ "EPUB" => 319 "HTML" => 4271 "PDF" => 739 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "The Pharmacokinetics of Recombinant Human Erythropoietin in Balkan Endemic Nephropathy Patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "478" "paginaFinal" => "485" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La farmacocinética de la eritropoyetina recombinante humana en pacientes con nefropatía endémica de los Balcanes" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11800_16025_42020_en_t111800_03_maquetacin_1.jpg" "Alto" => 673 "Ancho" => 2181 "Tamanyo" => 274482 ] ] "descripcion" => array:1 [ "en" => "Main characteristics of the patients" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vi¿nja Le¿aić, Nenad Petković, Ivko Marić, Branislava Miljković, Katarina Vučićević, Sanja Simić-Ogrizović, Vesna Pejovic, Ljubica Djukanović" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Vi¿nja" "apellidos" => "Le¿aić" ] 1 => array:2 [ "nombre" => "Nenad" "apellidos" => "Petković" ] 2 => array:2 [ "nombre" => "Ivko" "apellidos" => "Marić" ] 3 => array:2 [ "nombre" => "Branislava" "apellidos" => "Miljković" ] 4 => array:2 [ "nombre" => "Katarina" "apellidos" => "Vučićević" ] 5 => array:2 [ "nombre" => "Sanja" "apellidos" => "Simić-Ogrizović" ] 6 => array:2 [ "nombre" => "Vesna" "apellidos" => "Pejovic" ] 7 => array:2 [ "nombre" => "Ljubica" "apellidos" => "Djukanović" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699513052912" "doi" => "10.3265/Nefrologia.pre2013.Apr.11800" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052912?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141305291X?idApp=UINPBA000064" "url" => "/20132514/0000003300000004/v0_201502091629/X201325141305291X/v0_201502091630/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251413052936" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2013.Jan.11806" "estado" => "S300" "fechaPublicacion" => "2013-07-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2013;33:462-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7373 "formatos" => array:3 [ "EPUB" => 313 "HTML" => 6143 "PDF" => 917 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Natural progression of renal function in the elderly: analysis of poor prognosis factors associated with chronic kidney disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "462" "paginaFinal" => "469" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución natural de la función renal en el anciano: análisis de factores de mal pronóstico asociados a la enfermedad renal crónica" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11806_16025_48053_en_f1_11806.jpg" "Alto" => 1220 "Ancho" => 2109 "Tamanyo" => 204083 ] ] "descripcion" => array:1 [ "en" => "Decrease in the glomerular filtration rate in survivors of the study on Elderly patients with chronic kidney disease at 5 years" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "MANUEL HERAS, Manuel Heras, PEDRO GARCIA COSMES, Pedro García-Cosmes, MARIA JOSE FERNANDEZ-REYES, María J. Fernández-Reyes, ROSA SANCHEZ, Rosa Sánchez" "autores" => array:8 [ 0 => array:2 [ "nombre" => "MANUEL" "apellidos" => "HERAS" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Heras" ] 2 => array:2 [ "nombre" => "PEDRO" "apellidos" => "GARCIA COSMES" ] 3 => array:2 [ "nombre" => "Pedro" "apellidos" => "García-Cosmes" ] 4 => array:2 [ "nombre" => "MARIA JOSE" "apellidos" => "FERNANDEZ-REYES" ] 5 => array:2 [ "nombre" => "María J." "apellidos" => "Fernández-Reyes" ] 6 => array:2 [ "nombre" => "ROSA" "apellidos" => "SANCHEZ" ] 7 => array:2 [ "nombre" => "Rosa" "apellidos" => "Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699513052939" "doi" => "10.3265/Nefrologia.pre2013.Jan.11806" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052939?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052936?idApp=UINPBA000064" "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052936/v0_201502091630/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Costs and outcomes of endovascular treatment of thrombosed dialysis autogenous fistulae" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "470" "paginaFinal" => "477" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Luis Coentrao" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Luis" "apellidos" => "Coentrao" "email" => array:1 [ 0 => "coentrao@med.up.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Nephrology Research and Development Unit, Sao Joao Hospital Centre, Porto, Portugal, " "etiqueta" => "a" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Costos y resultados del tratamiento endovascular de las trombosis en las fístulas autólogas para hemodiálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11725_16025_41407_en_t111725_02_maquetacin_1.jpg" "Alto" => 715 "Ancho" => 2167 "Tamanyo" => 495312 ] ] "descripcion" => array:1 [ "en" => "Results of dialysis autogenous arteriovenous fistula (AVF) declotting procedures" ] ] ] "textoCompleto" => "INTRODUCTION The number of patients undergoing dialysis continues to increase as technology and patient survival improve in this patient population. Portugal has a higher incidence and prevalence of end stage-renal disease (ESRD) compared to most of other European countries. In 2011, a prevalence rate of 1662 patients per million of the population was registered by the Portuguese Society of Nephrology (10,409 patients underwent haemodialysis and 704 patients peritoneal dialysis in 2011). We know that vascular accesses for haemodialysis are plagued with multiple problems, the most common being infection and dysfunction. Although thrombosis of the vascular access is a relatively infrequent complication of autogenous arteriovenous fistulae (AVF), as current clinical practice guidelines recommend that at least 65% of ESRD population should have a functional AVF as a permanent dialysis access,1,2 AVF thrombosis has become a clinical challenge in our nephrology practice, with relevant clinical implications for dialysis patients. The challenge of determining the most effective treatment for thrombosed AVFs is paramount in the minds of the nephrologists. The goal of this article is to provide the reader an insight into the endovascular approaches of thrombosed AVFs, bearing in mind its clinical effectiveness and financial implications. PRE-PROCEDURAL PATIENT ASSESSMENT Before the thrombectomy procedure it is important to determine whether the patient has a history of significant cardiac or pulmonary disease. Patients who have a history of right-sided heart failure or pulmonary hypertension are not good candidates for an endovascular thrombectomy procedure since fragments of thrombus can escape from the AVF and travel to the lungs as pulmonary emboli during the procedure.3,4 In these particular clinical scenarios, therapy should be individualized, taking into account the risk-benefit of endovascular thrombectomy.The patient’s vascular access should be examined before draping the extremity. Fistula thrombosis is a clinical diagnosis characterized by the absence of flow in the AVF. Physical examination provides additional information that is of the utmost importance for the interventionalist since different endovascular approaches are used for AVFs with inflow, outflow, co-existing inflow–outflow problems or AVF thrombosis. Although clinical signs of infection should always be inspected, local inflammation and pain immediately upstream from the stenosis occur frequently in recently thrombosed native fistulae (phlebitis), and the diagnosis of infection is not easy to make.There are few contra-indications to percutanous declotting. Local infection is the main clinical contraindication. Huge clot burden (>100cc) and large aneurysms with old wall-adherent thrombi are both clinical and technical contraindications because safe removal of thrombi in such conditions is extremely difficult and hazardous to the patient. Immature AVF never previously used for haemodialysis, once considered as a technical contraindication, has recently been revisited by Miller et al.,5 reporting a highly success rate of endovascular salvage of immature clotted AVFs. PERCUTANOUS THROMBECTOMY PROCEDURE Throughout the past two decades, there has been a plethora of published reports describing numerous percutaneous techniques for the treatment of thrombosed haemodiaysis grafts and AVFs.6-19 These techniques can be divided into two broad categories; one group uses thrombolytic agents, and the other uses mechanical thrombectomy technique. The category of mechanical thrombectomy techniques includes balloon thrombectomy, mechanical thrombectomy devices and thromboaspiration. Basic Technique Percutaneous declotting of a dialysis AVFs is an outpatient procedure. Patients are monitored by a nurse with pulse oximetry, blood pressure measurement, and electrocardiography. Fentanyl and/or midazolam can be administered intravenously for conscious sedation. Puncture sites are anesthetized with lidocaine. Systemic heparinization with 5000UI of heparin is initiated prior to the procedure. Prophylactic antibiotics are recommended by some authors.13Although the technique for declotting a polytetrafluoroethylene graft can be standardized easily, clotted AVFs result in a wide range of difficulties: (a) the thin venous wall is more difficult to cannulate; (b) the anatomy is irregular, with the presence of collaterals veins; (c) the locations of the stenosis can occur anywhere, and are difficult to traverse; (d) a large volume clots can be encountered; and (e) aneurysms are more frequent than in polytetrafluoroethylene grafts.The technique for declotting a thrombosed AVFs has been well described by Turmel-Rodrigues et al.13 There are four basic steps to perform during a percutaneous thrombectomy procedure: (a) physical examination is essential to choose the best site for initial catheterization; (b) an initial venogram to evaluate the central and peripheral veins; (c) removal of the thrombus from the vascular access; and (d) treatment of all significant stenoses. An underlying stenosis is unmasked in the great majority of cases. In typical cases, an initial introducer sheath is placed a few centimeters from the anastomosis using an antegrade approach to treat the venous outfow. A catheter is pushed over a wire up to the superior vena cava and then slowly pulled back while contrast medium is injected under fluoroscopy to localize the downstream extension of the thrombosis. The fistula is abandoned at this stage if the venous outflow cannot be traversed or recanalized. A second introducer is placed with a retrograde approach in the direction of the arterial inflow. The fistula is abandoned if it is impossible to traverse the arteriovenous anastomosis with the guidewire. Occasionally, when the stenosis is clinically located a few centimeters from the wrist anastomosis, with no evidence of concomitant outflow stenosis, a single retrograde approach from the vein at the elbow is sufficient to treat the whole fistula. Once access to both the arterial inflow and venous outflow is guaranteed with a guidewire, thombi on the venous side are removed first, before the thrombi on the arterial side. Conventional, high-pressure or cutting balloon angioplasty should be undertaken to remove causative stenotic disease. On completion, both physical examination and fistulogram are performed to visualize the flow from arteriovenous anastomosis to the superior vena cava. Vascular sheaths are removed and haemostasis is achieved by manual compression or using a purse-string suture.20Occasionally, an AVF might clot with minimal or no thrombus. At other times, there is moderate-to-severe thrombus burden that accompanies AVF clotting. While percutaneous balloon angioplasty to correct the underlying stenosis might be all that is needed to declot a fistula with no thrombus, endovascular thromboaspiration is required to successfully declot a fistula with moderate thrombus and surgical referral is advisable in the presence of excessive thrombus burden. Thrombolysis  The introduction of mechanical thrombectomy devices has reduced the popularity of thrombolytic therapy. Urokinase, streptokinase, and tissue plasminogen activator (t-PA) have all been used for infusion thrombolysis.6,21,22 To achieve optimum outcome, anterograde vascular access is obtained as close to the arteriovenous anastomosis as possible. Thrombolytic therapy is then administered via a multiple side hole catheter along the length of the fistula for between 3-24 hours, at doses depending on institutional protocol. To improve outcome, adaptations to the technique have been published: pulse spray thrombolysis, in which highly concentrated fibrinolytic therapy is injected as a high-pressure spray directly into thrombus for 15-20 min, thereby reducing procedural time.6 Due to modest success rates, thrombolysis is more frequently used in combination with mechanical thrombectomy to maximize clot clearance and reduce procedural times. Mechanical thrombectomy  Several methods of mechanical clot dissolution have been published. Balloon thrombectomy was the first published “purely mechanical” percutaneous technique used for declotting thtombosed polytetrafluoroethylene grafts.23 This approach was accomplished using a variety of devices to macerate, dislodge or sweep thrombus from the occluded graft into the central venous circulation. This controversial technique was a milestone in the history of haemodialysis access declotting. From this experience gained in grafts, some teams successfully used this technique of deliberated pulmonary embolizations of clots when the volume of thrombus in the AVF was presumed to be equivalent to the encountered in grafts.22 Trerotola and colleagues stopped using this technique soon after, when they experiences a casualty.8 Other casualties have since been reported in the literature.3A wide range of mechanical thrombectomy devices have been used in the treatment of failed AVFs. The Arrow-Trerotola PTD (Arrow International, Reading, PA, USA) is a rotating nitinol basket available in 5 and 7 F configurations. A handheld battery powered motor results in a basket rotation speed of approximately 3,000rpm, macerating thrombus into particles of 1 to 3mm diameter.24,25 Thrombus fragments are then aspirated manually using the introducer sheath side port. Simple rotation of a 5 F mini-pigtail catheter (Cook Europe, Bjaeverskov, Denmark) can be used to remove thrombus from occluded AVFs.26 The Oasis recirculation catheter (Boston Scientific/Medi-Tech, Natick, MA) is available in 6 and 8 F systems and uses a standard angiographic pump injector.27 The Hydrolyser (Cordis, Miami, FL, USA) is a dual lumen 6 or 7F catheter with a distal side hole and rounded tip and requires the use of a conventional contrast injector to administer saline retrogradely.9,28-30 The AngioJet catheter (Possis Medical, Minneapolis, MN, USA) is available in 4 to 6F systems uses a specialized pump drive system that creates high pressures.14,31 The Amplatz thrombectomy device (ATD; Microvena, White Bear Lake, MN, USA) consists of a sharp blade that is rotated at 150,000rpm by a compressed gas driven turbine, within a protective metal capsule. Thrombus is macerated by the rotating blade and dispersed into the bloodstream as microscopic particles.15 Manual catheter-directed thromboaspiration is a popular technique in France and Spain that uses a straight 7 to 9F end-hole catheter (Guider; Boston Scientific, Natick, MA, USA; or Vista Bright Tip; Cordis, Miami, FL, USA) to remove thrombus by manual suction.13,32 SuccessNo single percutaneous thrombectomy technique has been proven to be more efficacious than other methods (Table 1). Limited data exist regarding outcome of declotting procedures in AVFs using thrombolysis alone. Zaleski et al.22 treated thrombosed AVFs with urokinase thrombolysis and balloon angioplasty and reported a procedural success rate of 82%. Primary patency rate of 64% was achieved at 12 months. Rocek et al.25 reported a 90% clinical success rate in 10 patients treated using the Arrow-Trerotola PTD. The 6-month primary patency rate was 60%. Shmitz-Rode et al.26 reported 100% clinical success rate in 15 AVFs and 11 grafts using the “rotating mini-pigtail catheter”, with a primary patency rate of 47% at 6 months. Sahni et al.27 treated 23 thrombosed accesses (5 AVFs and 17 grafts) using the Oasis catheter with a success rate of 86% and a primary patency rate of 50% at 6 months. Vorwek et al.28 reported a clinical success rate of 85% in 19 clotted AVFs and a primary patency rate of 50% at 12 months using the Hydrolyser catheter. Littler et al.31 published the outcomes of AngioJet thrombectomy in 44 occluded AVFs, with a technical success of 89% and a primary patency rate of 34% at 6 months. Similar results were confirmed by Moossavi et al.14. Recently, Yang et al.33 reported a higher success rate using the Arrow-Trerotola PTD, compared to the AngioJet catheter. However, comparable patency rates were obtained at one year of follow-up. A single study examining the clinical outcome of the ATD in occluded AVFs demonstrated a success rate of 89% and a primary patency of 27% at 12 months.15 Turmel-Rodrigues et al.13 reported the results of manual catheter-directed thromboaspiration technique, with a success rate of 93% for forearm and 76% for upper arm AVFs and a primary patency rate of 49% and 9% in the forearm and upper arm at 12 months, respectively. Similar results were reported by García Medina et al.32 and Bizarro et al.34.Intervention studies on thrombosed autogenous fistulae have predominantly appeared after the year 2000. A few have compared endovascular with surgical repair, but none was randomized. The results were comparable with the outcome of endovascular treatment in terms of primary success rate (90% versus 89%), but 1-year primary (74% versus 40%) and secondary patency rates (87% versus 72%) were higher.35 However, most studies on surgical thrombectomy of AVFs concerned forearm accesses with the creation of a new, more proximally located arteriovenous anastomosis.35-37 Complications The most frequent procedure-related complication associated with angioplasty of the dialysis vascular access is some type of venous rupture. This complication has been reported to represent 70–75% of all complications.38 Local complications, such as secondary bleeding and pseudoaneurism from the introducer sheath and vessel injury/disruption do occur in daily clinical practice,39 but probably are underreported in the literature.There are few significant procedure-related complications. The risk of pulmonary embolism is theoretically greater with autogenous AVFs than with polytetrafluoroethylene grafts.40, 41 However, clinically silent pulmonary embolism probably occurs in many patients treated by these methods.40 Arterial embolization can result from clot fragmentation at the arterial anastomosis by catheter or guidewire manipulation, vigorous injection of contrast material, or balloon angioplasty of residual thrombus. However, the reported frequency of arterial embolization has been low (0-7%).42 Major hemorrhagic complications requiring additional treatment are reported in 1-7% of cases in these series.42 Some experts advocate the use of prophylactic antibiotics due to the risk of infection.13 COSTSProbably, no topic has been so underreported in the nephrology literature as the analysis of costs of endovascular procedures for haemodialysis AVF failure. Vascular access costs may account for approximately 10% of the total cost of health care of haemodialysis patient population, with patients dialyzed with a catheter incurring the highest costs.43,44 It is well known for interventionalists that mechanical thrombectomy devices are expensive (e.g.  Arrow-Trerotola PTD, $600; Hydrolyzer, $600; Oasis, $600). However, they are not the ones responsible for the high expenditure of endovascular procedures. The amount of resources required for endovascular interventions vary among vascular access centers with different endovascular salvage procedures (Table 2). Therefore, cost analysis must take into account all the devices employed during the procedure (p.e. guidewires, balloon angioplasty, stents) the pharmacy (e.g. antibiotics, heparin, thrombolytics) and radiology costs (e.g. angiography suite, contrast media), professional fees and additional overhead expenses.Published findings regarding the economic value of vascular access surveillance revealed that adding access blood flow surveillance to clinical monitoring of grafts and AVFs may reduce thrombosis rates and costs.45-47 Bittl et al.48 recently reported an economic analysis of angiography and pre-emptive angioplasty to prevent haemodialysis access thrombosis. They observed that pre-emptive angiographic management of malfunctioning nonthrombosed haemodialysis accesses may represent a less efficient use of healthcare resources than increasing the number of patients with AVFs. To our knowledge, cost-effectiveness analyses of endovascular interventions for thrombosed haemodialysis accesses have been performed mainly in patients with clotted prosthetic grafts.49-51 Sands et al.49 performed a retrospective analysis comparing the clinical success and the costs of pharmacomechanical thrombolysis of occluded grafts with surgical thrombectomy. Hospitalization was required for 85% of the cases of surgical thrombectomy and in 17% of cases of pharmacomechanical thrombolysis. Hospital charges and physician costs were obtained for each procedure. Clinical success was similar between lysis and surgical procedures. Hospital, physician and total charges were significantly lower in the lysis group than in the surgical control (US$6,802 versus US$12,740). Vesely et al.50 prospectively randomized 20 patients with clotted grafts either to pulse-spray thrombolysis plus angioplasty, or surgical thrombectomy. Thrombolysis and surgical thrombectomy were performed as outpatient procedures in almost of the cases. The technical costs, professional fees, and all other associated costs were obtained. The authors concluded that endovascular thrombolysis and surgical thrombectomy were comparable in cost (US$6,062 versus US$5,580), and the technical success and patency rates were also similar. Dougherty et al.51 performed a similar study among 80 patients with clotted grafts. The mean cost of treatment (including room and supply costs but not professional fees) was significantly higher for the endovascular group than for the surgical group (US$2945 versus US$1512). In addition, high rate of technical failure necessitating surgery was observed in the endovascular group. To our knowledge, only recently the costs of percutaneous thrombectomy of clotted AVF were reported in the literature.34,48 Bizarro et al.34 reported a cost analysis of the use of manual catheter-directed thromboaspiration for the treatment of thrombosed AVFs. A comprehensive measurement of total vascular access care-related costs was obtained. The authors reported that the cost of maintenance of thrombosed AVFs by endovascular means was high. The mean total expense of the percutaneous thrombectomy procedure was US$1,381 and for percutaneous transluminal angioplasty was US$785. At one year of follow-up, the mean cumulative cost of vascular access care was US$2,504 per patient-year at risk. The mean cost was greatest for patients with brachiocephalic AVFs (US$3,578) than for patients with forearm AVFs (US$1,604). In comparison, in the Bittl et al. study48 procedure costs were approximately two times higher (angioplasty, US$1,939; percutaneous thrombectomy, US$3,361). Possible explanations for the differences observed in these two studies are: (a) in the first study,34 the investigators used manual catheter-directed thromboaspiration technique whereas Bittl et al.48 used the AngioJet catheter for thrombosed AVFs; (b) stents were not used in the first study,34 whereas Bittl et al.48 placed stents for several indications and; (c) physician billing differ among countries.52Percutaneous thrombectomy is an effective policy to treat thrombosed failed AVFs. Yes, but an expensive one. Do we, nephrologists, have other cost-effective approaches to deal with failed AVF? Does surgical thrombectomy may overcome the high financial burden of percutaneous thrombectomy, with similar success rates? Does the abandon of failed AVFs toward the creation of a new permanent accesss still an option? To our knowledge, clear-cut data has not been published answering these questions. Recenlty, Miller et al.5 evaluated the efficacy, functionality, and cost associated with the use of percutaneous techniques for the salvage of thrombosed immature fistulae. All fistulae had thrombosed following access creation and had never been used for haemodialysis. The authors concluded that endovascular techniques yield significant cost savings over access abandonment. Coentrão et al.53 compared two distinct policies for the maintenance of vascular access in prevalent haemodiaysis patients with thrombosed AVFs: percutaneous thrombectomy versus central venous catheterization to bridge the interval until a new AVF is suitable for cannulation. The authors observed that AVF salvage by endovascular therapy led to a near two-fold reduction in access-related expenses; the added costs associated with the procedure itself was completely offset by the saving associated with lower surgical visits, access dysfunction, and hospitalizations.Taking into consideration the published high success rates and the costs of percutaneous thrombectomy of occluded autogenous fistulae, nephrologists, Medical Societies and National Health Services face a new era of vascular access care. If the final decision is to treat failed AVFs, intensive efforts should be undertaken to universalize these interventions. Key concept Several studies have reported on the feasibility and relatively high-clinical success rate of the endovascular approach to thrombosed autogenous arteriovenous fistulae in recent years. However, maintenance of a previously thrombosed arteriovenous fistulae require repeated interventions and thus could be a highly expensive policy. Further prospective cost-effectiveness analyses comparing different thrombectomy procedures (endovascular versus surgery) and distinct approaches for the maintenance of functional autogenous fistulae (pre-emptive angioplasty versus percutaneous thrombectomy) need to be carried out. Conflict of interest The authors declare that they have no conflicts of interest related to the contents of this article.<a href="grande/11725_16025_41407_en_t111725_02_maquetacin_1.jpg" class="elsevierStyleCrossRefs"><img src="11725_16025_41407_en_t111725_02_maquetacin_1.jpg" alt="Results of dialysis autogenous arteriovenous fistula (AVF) declotting procedures"></img></a>Table 1. Results of dialysis autogenous arteriovenous fistula (AVF) declotting procedures<a href="grande/11725_16025_41408_en_t211725_02_maquetacin_1.jpg" class="elsevierStyleCrossRefs"><img src="11725_16025_41408_en_t211725_02_maquetacin_1.jpg" alt="Costs of endovascular procedures for dysfunctional and thrombosed haemodialysis autogenous arteriovenous fistula (AVF) and polytetrafluoroethylene graft (PTFE)"></img></a>Table 2. Costs of endovascular procedures for dysfunctional and thrombosed haemodialysis autogenous arteriovenous fistula (AVF) and polytetrafluoroethylene graft (PTFE)" "pdfFichero" => "P1-E557-S4293-A11725-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440115" "palabras" => array:1 [ 0 => "Análisis de costo" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440117" "palabras" => array:1 [ 0 => "Análisis económico" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440119" "palabras" => array:1 [ 0 => "Fístula arteriovenosa autóloga" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440121" "palabras" => array:1 [ 0 => "Trombectomía percutánea" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440123" "palabras" => array:1 [ 0 => "Diálisis" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440125" "palabras" => array:1 [ 0 => "Tratamiento endovascular" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440116" "palabras" => array:1 [ 0 => "Cost analysis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440118" "palabras" => array:1 [ 0 => "Economic analysis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440120" "palabras" => array:1 [ 0 => "Autogenous arteriovenous fistulae" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440122" "palabras" => array:1 [ 0 => "Percutaneous thrombectomy" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440124" "palabras" => array:1 [ 0 => "Dialysis" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440126" "palabras" => array:1 [ 0 => "Endovascular treatment" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "El acceso vascular funcional es un requisito previo para el tratamiento renal sustitutivo en pacientes con enfermedad renal crónica. Las fístulas autólogas se consideran superiores a las prótesis vasculares y los catéteres venosos centrales; sin embargo, las fístulas no están exentas de problemas. Las trombosis de la fístula autóloga se han convertido en un reto en la práctica clínica de nefrología, con importantes implicaciones clínicas para pacientes en diálisis. Varios estudios han informado sobre la viabilidad y la tasa relativamente alta del éxito clínico del abordaje endovascular de fístulas trombosadas en los últimos años. Sin embargo, como las repetidas intervenciones suelen ser necesarias para lograr la supervivencia a largo plazo del acceso, el mantenimiento de una fístula anteriormente trombosada podría ser una política muy cara. Los objetivos de este artículo son proporcionar al lector una idea de los múltiples enfoques endovasculares para fístulas autólogas trombosadas, teniendo en cuenta su eficacia clínica y las implicaciones financieras." ] "en" => array:1 [ "resumen" => "Functional vascular access is a prerequisite for adequate haemodialysis treatment in patients with end-stage renal disease. Autogenous arteriovenous fistulae are considered superior to synthetic grafts and central venous catheters; however, fistulae are not without problems. Fistulae thrombosis has become a clinical challenge in nephrology practice, with relevant clinical implications for dialysis patients. Several studies have reported on the feasibility and relatively high-clinical success rate of the endovascular approach to thrombosed fistulae in recent years. However, as repeated interventions are usually required to achieve long-term access survival, maintenance of a previously thrombosed fistulae could be a highly expensive policy. The goals of this article are to provide the reader an insight into the multiple endovascular approaches for thrombosed arteriovenous fistulae, bearing in mind its clinical effectiveness and financial implications." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11725_16025_41407_en_t111725_02_maquetacin_1.jpg" "Alto" => 715 "Ancho" => 2167 "Tamanyo" => 495312 ] ] "descripcion" => array:1 [ "en" => "Results of dialysis autogenous arteriovenous fistula (AVF) declotting procedures" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11725_16025_41408_en_t211725_02_maquetacin_1.jpg" "Alto" => 692 "Ancho" => 2158 "Tamanyo" => 330772 ] ] "descripcion" => array:1 [ "en" => "Costs of endovascular procedures for dysfunctional and thrombosed haemodialysis autogenous arteriovenous fistula (AVF) and polytetrafluoroethylene graft (PTFE)" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:53 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tordoir J, Canaud B, Haage P, Konner K,\u{A0}Basci A,\u{A0}Fouque D,\u{A0}et al. EBPG on vascular access. Nephrol Dial Transplant 2007;22 Suppl 2:ii88-ii117." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vascular\u{A0}Access\u{A0}2006 Work Group.\u{A0}KDOQI: Clinical practice guidelines and clinical practice recommendations for vascular access. Am J Kidney Dis 2006;48: S176-S247. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16813989" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "SwanTL, Smyth SH, Ruffenbach SJ, Berman SS, Pond GD. Pulmonary embolism following hemodialysis access thrombolysis/thrombectomy. J Vasc Interv Radiol 1995;6:683-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8541667" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Trerotola SO, Johnson MS, Schauwecker DS, Davidson DD,\u{A0}Filo RS,\u{A0}Zhou XH,\u{A0}et al. Pulmonary emboli from pulse-spray and mechanical thrombolysis: evaluation with an animal diaysis-graft model. Radiology 1996;200:169-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8657906" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Miller GA, Hwang W, Preddie D, Khariton A,\u{A0}Savransky Y. Percutaneous salvage of thrombosed immature arteriovenous fistulas. Semin Dial 2011;24:107-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21338402" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Valji K, Bookstein JJ, Roberts AC, Oglevie SB,\u{A0}Pittman C,\u{A0}O'Neill MP.\u{A0}Pulse-spray pharmacomechanical thrombolysis of thrombosed hemodialysis access grafts: comparison of original and current techniques. AJR Am J Roentgenol 1995;165:1495-500." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Beathard GA, Welch BR, Maidment HJ. Mechanical thrombolysis for the treatment of thrombosed hemodialysis grafts. Radiology 1996;200:711-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8756920" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Trerotola SO, Vesely TM, Lung GB, Soulen MC,\u{A0}Ehrman KO,\u{A0}Cardella JF. Treatment of thrombosed hemodialysis access grafts: Arrow-Trerotola percutaneous thrombolytic device versus pulse-spray thrombolysis. Radiology 1998;206:403-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9457193" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vorwerk D,\u{A0}Schurmann K,\u{A0}Müller-Leisse C,\u{A0}Adam G,\u{A0}Bücker A,\u{A0}Sohn M, et al. Hemodynamic thrombectomy of haemodialysis grafts and fistulae: results of 51 procedures. Nephrol Dial Transplant 1996;11:1058-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8671969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Uflacker R, Rajagopalan PR, Vujic I, Stutley JE. Treatment of thombosed dialysis access grafts: randomized trial of surgical thrombectomy versus mechanical thrombectomy with the amplatz device. J Vasc\u{A0} Interv Radiol 1996;7:185-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9007796" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vesely TM,\u{A0}Williams D,\u{A0}Weiss M,\u{A0}Hicks M,\u{A0}Stainken B,\u{A0}Matalon T, et al. Comparison of the AngioJet rheolytic catheter to surgical thrombectomy for the treatment of thrombosed hemodialysis grafts. J Vasc Interv Radiol 1999;10:1195-205. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10527197" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Turmel-Rodrigues L,\u{A0}Sapoval M,\u{A0}Pengloan J,\u{A0}Billaux L,\u{A0}Testou D,\u{A0}Hauss S, et al. Manual thromboaspiration and dilation of thrombosed dialysis access: Mid-term results of a simple concept. J Vasc Interv Radiol 1997;8:813-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9314373" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Turmel-Rodrigues L,\u{A0}Pengloan J,\u{A0}Rodrigue H,\u{A0}Brillet G,\u{A0}Lataste A,\u{A0}Pierre D, et al. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int 2000;57:1124-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10720965" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Moossavi S, Regan JD, Pierson ED, Kasey JM, Tuttle AB, Vachharajani TJ, et al. Nonsurgical salvage of thrombosed arterio-venous fistulae: A case series and review of the literature. Semin Dial 2007;20:459-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17897255" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Haage P, Vorwerk D, Wilberger JE, Piroth W,\u{A0}Schürmann K,\u{A0}Günther RW. Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae. Kidney Int 2000;57:1169-75. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10720969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Liang HL,\u{A0}Pan HB,\u{A0}Chung HM,\u{A0}Ger LP,\u{A0}Fang HC,\u{A0}Wu TH, et al. Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty. Radiology 2002;223:339-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11997535" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rajan DK,\u{A0}Clark TW,\u{A0}Simons ME,\u{A0}Kachura JR,\u{A0}Sniderman K. Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas. J Vasc Interv Radiol 2002;13:1211-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12471184" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shatsky JB, Berns JS, Clark TW, Kwak A,\u{A0}Tuite CM,\u{A0}Shlansky-Goldberg RD,\u{A0}et al. Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol 2005;16:1605-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16371525" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jain G, Maya ID, Allon M. Outcomes of percutaneous mechanical thrombectomy of arteriovenous fistulas in hemodialysis patients. Semin Dial 2008;21:581-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19000116" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vorwerk D,\u{A0}Konner K,\u{A0}Schürmann K,\u{A0}Günther RW. A simple trick to facilitate bleeding control after percutaneous hemodialysis fistula and graft interventions. Cardiovasc Intervent Radiol 1997;20:159-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9030511" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109708021165" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Klimas VA,\u{A0}Denny KM,\u{A0}Paganini EP,\u{A0}Graor RA,\u{A0}Nakamoto S,\u{A0}Risius B, et al. Low dose streptokinase therapy for thrombosed arteriovenous fistulas. Trans Am Soc Artif Intern Organs 1984;30:511-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6533933" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zaleski GX,\u{A0}Funaki B,\u{A0}Kenney S,\u{A0}Lorenz JM,\u{A0}Garofalo R. Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas. J Vasc Interv Radiol 1999;10:129-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10082098" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Trerotola SO,\u{A0}Lund GB,\u{A0}Scheel PJ Jr,\u{A0}Savader SJ,\u{A0}Venbrux AC,\u{A0}Osterman FA Jr. Thrombosed dialysis access grafts: percutaneous mechanical declotting without urokinase. Radiology 1994;191:721-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8184052" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Trerotola SO,\u{A0}McLennan G,\u{A0}Davidson D,\u{A0}Lane KA,\u{A0}Ambrosius WT,\u{A0}Lazzaro C,\u{A0}et al. Preclinical in vivo testing of the Arrow-Trerotola percutaneous thrombolytic device for venous thrombosis. J Vasc Interv Radiol 2001;12:95-103. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11200360" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rocek M,\u{A0}Peregrin JH,\u{A0}Lasovicková J,\u{A0}Krajícková D,\u{A0}Slavíoková M. Mechanical thrombolysis of thrombosed hemodialysis native fistulas with use of the Arrow-Trerotola percutaneous thrombolytic device: our preliminary experience. J Vasc Interv Radiol 2000;11:1153-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11041471" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schmitz-Rode T,\u{A0}Wildberger JE,\u{A0}Hübner D,\u{A0}Wein B,\u{A0}Schürmann K,\u{A0}Günther RW. Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study. J Vasc Interv Radiol 2000;11:721-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10877416" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sahni V,\u{A0}Kaniyur S,\u{A0}Malhotra A,\u{A0}Fan S,\u{A0}Blakeney C,\u{A0}Fotheringham T, et al. Mechanical thrombectomy of occluded hemodialysis native fistulas and grafts using a hydrodynamic thrombectomy catheter: preliminary experience. Cardiovasc Intervent Radiol 2005;28:714-21. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16059764" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vorwerk D,\u{A0}Schurmann K,\u{A0}Müller-Leisse C,\u{A0}Adam G,\u{A0}Bücker A,\u{A0}Sohn M, et al. Hydrodynamic thrombectomy of haemodialysis grafts and fistulae: results of 51 procedures. Nephrol Dial Transplant 1996;11:1058-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8671969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Overbosch EH,\u{A0}Pattynama PM,\u{A0}Aarts HJ,\u{A0}Schultze Kool LJ,\u{A0}Hermans J,\u{A0}Reekers JA. Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter. Radiology 1996;201:485-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8888246" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rousseau H,\u{A0}Sapoval M,\u{A0}Ballini P,\u{A0}Dube M,\u{A0}Joffre F,\u{A0}Gaux JC, et al. Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser). Eur Radiol 1997;7:935-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9228112" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Littler P,\u{A0}Cullen N,\u{A0}Gould D,\u{A0}Bakran A,\u{A0}Powell S. AngioJet thrombectomy for occluded dialysis fistulae: outcome data. Cardiovasc Intervent Radiol 2009;32:265-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19115071" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109711014884" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García Medina J,\u{A0}Lacasa Pérez N,\u{A0}Muray Cases S,\u{A0}Pérez Garrido I,\u{A0}García Medina V. Accesos vasculares para hemodiálisis trombosados: rescate mediante técnicas de radiología vascular intervencionista. Nefrologia 2009;29:249-55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19554059" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yang CC, Yang CW, Wen SC, Wu CC. Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas. Catheter Cardiovasc Interv 2012;80(6):1035-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22511560" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bizarro P,\u{A0}Coentrão L,\u{A0}Ribeiro C,\u{A0}Neto R,\u{A0}Pestana M. Endovascular treatment of thrombosed dialysis fistulae: a cumulative cost analysis. Catheter Cardiovasc Interv. 2011;77:1065-1070. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21413132" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tordoir JH,\u{A0}Bode AS,\u{A0}Peppelenbosch N,\u{A0}van der Sande FM,\u{A0}de Haan MW. Surgical or endovascular repair of thrombosed dialysis vascular access: Is there any evidence? J Vasc Surg 2009;50:953-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19786244" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ponikvar R. Surgical salvage of thrombosed arteriovenous fistulas and grafts. Ther Apher Dial 2005;9:245-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15966999" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lipari G,\u{A0}Tessitore N,\u{A0}Poli A,\u{A0}Bedogna V,\u{A0}Impedovo A,\u{A0}Lupo A, et al. Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for haemodialysis. Nephrol Dial Transplant 2007;22:2605-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17517799" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Beathard GA, Urbanes A, Litchfield A. The classification of procedure related complications-a fresh approach. Semin Dial 2006;19:527-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17150055" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Renaud CJ,\u{A0}Lopes K,\u{A0}Bourquelot P,\u{A0}Turmel-Rodrigues L. Skin and venous rupture at a hemodialysis needle cannulation site during angioplasty of a transposed forearm fistula. J Vasc Interv Radiol\u{A0} 2011;22:1488-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21961984" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dolmatch BL, Gray RJ, Horton KM. Will iatrogenic pulmonary embolization be our pulmonary embarrassment? Radiology 1994;191:615-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Swan TL,\u{A0}Smyth SH,\u{A0}Ruffenach SJ,\u{A0}Berman SS,\u{A0}Pond GD. Pulmonary embolism following hemodialysis access thrombolysis/thrombectomy. J Vasc Interv Radiol 1995;6:683-86." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Valji K. Transcatheter treatment of thrombosed hemodialysis access grafts. AJR Am J Roentgenol 1995;164:823-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7726032" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "USRDS: The economic cost of ESRD, vascular access procedures, and medicare spending for alternative modalities of treatment. Am J Kidney Dis 1997;30:S160-S177. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9259700" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Amedia CA Jr,\u{A0}Bolton WK,\u{A0}Cordray T,\u{A0}Hakim R,\u{A0}Howard R,\u{A0}Jackson J, et al. Vascular access for HD: aligning payment with quality. Semin Dial 2011;24:37-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21338392" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 44 => array:3 [ "identificador" => "bib45" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tessitore N,\u{A0}Bedogna V,\u{A0}Poli A,\u{A0}Mantovani W,\u{A0}Lipari G,\u{A0}Baggio E, et al. Adding access blood flow surveillance to clinical monitoring reduces thrombosis rates and costs, and improves fistula patency in the short term: A controlled cohort study. Nephrol Dial Transplant 2008;23:3578-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511608" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 45 => array:3 [ "identificador" => "bib46" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "McCarley P,\u{A0}Wingard RL,\u{A0}Shyr Y,\u{A0}Pettus W,\u{A0}Hakim RM,\u{A0}Ikizler TA. Vascular access blood flow monitoring reduces access morbidity and costs. Kidney Int 2001;60:1164-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11532113" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 46 => array:3 [ "identificador" => "bib47" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wijnen E,\u{A0}Planken N,\u{A0}Keuter X,\u{A0}Kooman JP,\u{A0}Tordoir JH,\u{A0}de Haan MW,\u{A0}et al. Impact of a quality improvement programme based on vascular access flow monitoring on costs, access occlusion and access failure. Nephrol Dial Transplant 2006;21:3514-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16921189" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 47 => array:3 [ "identificador" => "bib48" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bittl JA, Cohen DJ, Seek MM, Feldman RL. Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis access thrombosis. Catheter Cardiovasc Interv 2010;75:14-21. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19862805" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0085253815536491" "estado" => "S300" "issn" => "00852538" ] ] ] ] ] ] ] 48 => array:3 [ "identificador" => "bib49" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sands JJ, Patel S, Plaviak DJ, Miranda CL. Pharmacomechanical thrombolysis with urokinase for treatment of thrombosed hemodialysis access grafts. ASAIO J 1994;40:M886-M888. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8555639" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 49 => array:3 [ "identificador" => "bib50" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vesely TM,\u{A0}Idso MC,\u{A0}Audrain J,\u{A0}Windus DW,\u{A0}Lowell JA, et al. Thrombolysis versus surgical thrombectomy for the treatment of dialysis graft thrombosis: Pilot study comparing costs. J Vasc Interv Radiol 1996;7:507-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8855526" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 50 => array:3 [ "identificador" => "bib51" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dougherty MJ,\u{A0}Calligaro KD,\u{A0}Schindler N,\u{A0}Raviola CA,\u{A0}Ntoso A. Endovascular versus surgical treatment for thrombosed hemodialysis grafts: A prospective, randomized study. J Vasc Surg 1999;30:1016-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10587385" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 51 => array:3 [ "identificador" => "bib52" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "World Bank: World Development Indicators 2000. Washington DC: World Bank; 2001." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 52 => array:3 [ "identificador" => "bib53" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Coentrão L, Bizarro P, Ribeiro C, Neto R, Pestana M. Percutaneous treatment of thrombosed arteriovenous fistulas: clinical and economic implications. Clin J Am Soc Nephrol 2010;5:2245-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20798249" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052928/v0_201502091630/en/main.assets" "Apartado" => array:4 [ "identificador" => "35445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short Reviews" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000004/v0_201502091629/X2013251413052928/v0_201502091630/en/P1-E557-S4293-A11725-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052928?idApp=UINPBA000064"]

Statistics

Costos y resultados del tratamiento endovascular de las trombosis en las fístulas autólogas para hemodiálisis

Luis Coentraoa

a Nephrology Research and Development Unit, Sao Joao Hospital Centre, Porto, Portugal,

Read

13099

Times
was read the article

2832

Total PDF

10267

Total HTML

Share statistics

 array:21 [
  "pii" => "X2013251413052928"
  "issn" => "20132514"
  "doi" => "10.3265/Nefrologia.pre2013.Feb.11725"
  "estado" => "S300"
  "fechaPublicacion" => "2013-07-01"
  "documento" => "article"
  "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
  "subdocumento" => "fla"
  "cita" => "Nefrologia &#40;English Version&#41;. 2013;33:470-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 7846
    "formatos" => array:3 [
      "EPUB" => 282
      "HTML" => 6707
      "PDF" => 857
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:17 [
      "pii" => "X0211699513052920"
      "issn" => "02116995"
      "doi" => "10.3265/Nefrologia.pre2013.Feb.11725"
      "estado" => "S300"
      "fechaPublicacion" => "2013-07-01"
      "documento" => "article"
      "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
      "subdocumento" => "fla"
      "cita" => "Nefrologia. 2013;33:470-7"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 6663
        "formatos" => array:3 [
          "EPUB" => 280
          "HTML" => 5678
          "PDF" => 705
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "titulo" => "Costos y resultados del tratamiento endovascular de las trombosis en las f&#237;stulas aut&#243;logas para hemodi&#225;lisis"
        "tienePdf" => "es"
        "tieneTextoCompleto" => 0
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "470"
            "paginaFinal" => "477"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Costs and outcomes of endovascular treatment of thrombosed dialysis autogenous fistulae"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Luis Coentrao"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "Luis"
                "apellidos" => "Coentrao"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "X2013251413052928"
          "doi" => "10.3265/Nefrologia.pre2013.Feb.11725"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052928?idApp=UINPBA000064"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052920?idApp=UINPBA000064"
      "url" => "/02116995/0000003300000004/v0_201502091404/X0211699513052920/v0_201502091404/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:17 [
    "pii" => "X201325141305291X"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2013.Apr.11800"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2013;33:478-85"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 5329
      "formatos" => array:3 [
        "EPUB" => 319
        "HTML" => 4271
        "PDF" => 739
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "The Pharmacokinetics of Recombinant Human Erythropoietin in Balkan Endemic Nephropathy Patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "478"
          "paginaFinal" => "485"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La farmacocin&#233;tica de la eritropoyetina recombinante humana en pacientes con nefropat&#237;a end&#233;mica de los Balcanes"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Tab.  1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11800_16025_42020_en_t111800_03_maquetacin_1.jpg"
              "Alto" => 673
              "Ancho" => 2181
              "Tamanyo" => 274482
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Main characteristics of the patients"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Vi&#191;nja Le&#191;ai&#263;, Nenad Petkovi&#263;, Ivko Mari&#263;, Branislava Miljkovi&#263;, Katarina Vu&#269;i&#263;evi&#263;, Sanja Simi&#263;-Ogrizovi&#263;, Vesna Pejovic, Ljubica Djukanovi&#263;"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Vi&#191;nja"
              "apellidos" => "Le&#191;ai&#263;"
            ]
            1 => array:2 [
              "nombre" => "Nenad"
              "apellidos" => "Petkovi&#263;"
            ]
            2 => array:2 [
              "nombre" => "Ivko"
              "apellidos" => "Mari&#263;"
            ]
            3 => array:2 [
              "nombre" => "Branislava"
              "apellidos" => "Miljkovi&#263;"
            ]
            4 => array:2 [
              "nombre" => "Katarina"
              "apellidos" => "Vu&#269;i&#263;evi&#263;"
            ]
            5 => array:2 [
              "nombre" => "Sanja"
              "apellidos" => "Simi&#263;-Ogrizovi&#263;"
            ]
            6 => array:2 [
              "nombre" => "Vesna"
              "apellidos" => "Pejovic"
            ]
            7 => array:2 [
              "nombre" => "Ljubica"
              "apellidos" => "Djukanovi&#263;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513052912"
        "doi" => "10.3265/Nefrologia.pre2013.Apr.11800"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052912?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141305291X?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000004/v0_201502091629/X201325141305291X/v0_201502091630/en/main.assets"
  ]
  "itemAnterior" => array:17 [
    "pii" => "X2013251413052936"
    "issn" => "20132514"
    "doi" => "10.3265/Nefrologia.pre2013.Jan.11806"
    "estado" => "S300"
    "fechaPublicacion" => "2013-07-01"
    "documento" => "article"
    "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/"
    "subdocumento" => "fla"
    "cita" => "Nefrologia &#40;English Version&#41;. 2013;33:462-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 7373
      "formatos" => array:3 [
        "EPUB" => 313
        "HTML" => 6143
        "PDF" => 917
      ]
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "titulo" => "Natural progression of renal function in the elderly&#58; analysis of poor prognosis factors associated with chronic kidney disease"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "462"
          "paginaFinal" => "469"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Evoluci&#243;n natural de la funci&#243;n renal en el anciano&#58; an&#225;lisis de factores de mal pron&#243;stico asociados a la enfermedad renal cr&#243;nica"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig1"
          "etiqueta" => "Fig. 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "copyright" => "Elsevier Espa&#241;a"
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "11806_16025_48053_en_f1_11806.jpg"
              "Alto" => 1220
              "Ancho" => 2109
              "Tamanyo" => 204083
            ]
          ]
          "descripcion" => array:1 [
            "en" => "Decrease in the glomerular filtration rate in survivors of the study on Elderly patients with chronic kidney disease at 5 years"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "MANUEL HERAS, Manuel Heras, PEDRO GARCIA COSMES, Pedro Garc&#237;a-Cosmes, MARIA JOSE FERNANDEZ-REYES, Mar&#237;a J&#46; Fern&#225;ndez-Reyes, ROSA SANCHEZ, Rosa S&#225;nchez"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "MANUEL"
              "apellidos" => "HERAS"
            ]
            1 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Heras"
            ]
            2 => array:2 [
              "nombre" => "PEDRO"
              "apellidos" => "GARCIA COSMES"
            ]
            3 => array:2 [
              "nombre" => "Pedro"
              "apellidos" => "Garc&#237;a-Cosmes"
            ]
            4 => array:2 [
              "nombre" => "MARIA JOSE"
              "apellidos" => "FERNANDEZ-REYES"
            ]
            5 => array:2 [
              "nombre" => "Mar&#237;a J&#46;"
              "apellidos" => "Fern&#225;ndez-Reyes"
            ]
            6 => array:2 [
              "nombre" => "ROSA"
              "apellidos" => "SANCHEZ"
            ]
            7 => array:2 [
              "nombre" => "Rosa"
              "apellidos" => "S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "X0211699513052939"
        "doi" => "10.3265/Nefrologia.pre2013.Jan.11806"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699513052939?idApp=UINPBA000064"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052936?idApp=UINPBA000064"
    "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052936/v0_201502091630/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "titulo" => "Costs and outcomes of endovascular treatment of thrombosed dialysis autogenous fistulae"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "470"
        "paginaFinal" => "477"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "Luis Coentrao"
        "autores" => array:1 [
          0 => array:4 [
            "nombre" => "Luis"
            "apellidos" => "Coentrao"
            "email" => array:1 [
              0 => "coentrao&#64;med&#46;up&#46;pt"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:3 [
            "entidad" => "Nephrology Research and Development Unit, Sao Joao Hospital Centre, Porto,  Portugal, "
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Costos y resultados del tratamiento endovascular de las trombosis en las f&#237;stulas aut&#243;logas para hemodi&#225;lisis"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11725_16025_41407_en_t111725_02_maquetacin_1.jpg"
            "Alto" => 715
            "Ancho" => 2167
            "Tamanyo" => 495312
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Results of dialysis autogenous arteriovenous fistula &#40;AVF&#41; declotting procedures"
        ]
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The number of patients undergoing dialysis continues to increase as technology and patient survival improve in this patient population&#46; Portugal has a higher incidence and prevalence of end stage-renal disease &#40;ESRD&#41; compared to most of other European countries&#46; In 2011&#44; a prevalence rate of 1662 patients per million of the population was registered by the Portuguese Society of Nephrology &#40;10&#44;409 patients underwent haemodialysis and 704 patients peritoneal dialysis in 2011&#41;&#46; We know that vascular accesses for haemodialysis are plagued with multiple problems&#44; the most common being infection and dysfunction&#46; Although thrombosis of the vascular access is a relatively infrequent complication of autogenous arteriovenous fistulae &#40;AVF&#41;&#44; as current clinical practice guidelines recommend that at least 65&#37; of ESRD population should have a functional AVF as a permanent dialysis access&#44;<span class="elsevierStyleSup">1&#44;2</span> AVF thrombosis has become a clinical challenge in our nephrology practice&#44; with relevant clinical implications for dialysis patients&#46; The challenge of determining the most effective treatment for thrombosed AVFs is paramount in the minds of the nephrologists&#46; The goal of this article is to provide the reader an insight into the endovascular approaches of thrombosed AVFs&#44; bearing in mind its clinical effectiveness and financial implications&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PRE-PROCEDURAL PATIENT ASSESSMENT</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Before the thrombectomy procedure it is important to determine whether the patient has a history of significant cardiac or pulmonary disease&#46; Patients who have a history of right-sided heart failure or pulmonary hypertension are not good candidates for an endovascular thrombectomy procedure since fragments of thrombus can escape from the AVF and travel to the lungs as pulmonary emboli during the procedure&#46;<span class="elsevierStyleSup">3&#44;4</span> In these particular clinical scenarios&#44; therapy should be individualized&#44; taking into account the risk-benefit of endovascular thrombectomy&#46;</p><p class="elsevierStylePara">The patient&#8217;s vascular access should be examined before draping the extremity&#46; Fistula thrombosis is a clinical diagnosis characterized by the absence of flow in the AVF&#46; Physical examination provides additional information that is of the utmost importance for the interventionalist since different endovascular approaches are used for AVFs with inflow&#44; outflow&#44; co-existing inflow&#8211;outflow problems or AVF thrombosis&#46; Although clinical signs of infection should always be inspected&#44; local inflammation and pain immediately upstream from the stenosis occur frequently in recently thrombosed native fistulae &#40;phlebitis&#41;&#44; and the diagnosis of infection is not easy to make&#46;</p><p class="elsevierStylePara">There are few contra-indications to percutanous declotting&#46; Local infection is the main clinical contraindication&#46; Huge clot burden &#40;&#62;100cc&#41; and large aneurysms with old wall-adherent thrombi are both clinical and technical contraindications because safe removal of thrombi in such conditions is extremely difficult and hazardous to the patient&#46; Immature AVF never previously used for haemodialysis&#44; once considered as a technical contraindication&#44; has recently been revisited by Miller&#160;et al&#46;&#44;<span class="elsevierStyleSup">5</span> reporting a highly success rate of endovascular salvage of immature clotted AVFs&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">PERCUTANOUS THROMBECTOMY PROCEDURE</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Throughout the past two decades&#44; there has been a plethora of published reports describing numerous percutaneous techniques for the treatment of thrombosed haemodiaysis grafts and AVFs&#46;<span class="elsevierStyleSup">6-19</span> These techniques can be divided into two broad categories&#59; one group uses thrombolytic agents&#44; and the other uses mechanical thrombectomy technique&#46; The category of mechanical thrombectomy techniques includes balloon thrombectomy&#44; mechanical thrombectomy devices and thromboaspiration&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Basic Technique</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Percutaneous declotting of a dialysis AVFs is an outpatient procedure&#46; Patients are monitored by a nurse with pulse oximetry&#44; blood pressure measurement&#44; and electrocardiography&#46; Fentanyl and&#47;or midazolam can be administered intravenously for conscious sedation&#46; Puncture sites are anesthetized with lidocaine&#46; Systemic heparinization with 5000UI of heparin is initiated prior to the procedure&#46; Prophylactic antibiotics are recommended by some authors&#46;<span class="elsevierStyleSup">13</span></p><p class="elsevierStylePara">Although the technique for declotting a polytetrafluoroethylene graft can be standardized easily&#44; clotted AVFs result in a wide range of difficulties&#58; &#40;a&#41; the thin venous wall is more difficult to cannulate&#59; &#40;b&#41; the anatomy is irregular&#44; with the presence of collaterals veins&#59; &#40;c&#41; the locations of the stenosis can occur anywhere&#44; and are difficult to traverse&#59; &#40;d&#41; a large volume clots can be encountered&#59; and &#40;e&#41; aneurysms are more frequent than in polytetrafluoroethylene grafts&#46;</p><p class="elsevierStylePara">The technique for declotting a thrombosed AVFs has been well described by Turmel-Rodrigues&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">13</span> There are four basic steps to perform during a percutaneous thrombectomy procedure&#58; &#40;a&#41; physical examination is essential to choose the best site for initial catheterization&#59; &#40;b&#41; an initial venogram to evaluate the central and peripheral veins&#59; &#40;c&#41; removal of the thrombus from the vascular access&#59; and &#40;d&#41; treatment of all significant stenoses&#46; An underlying stenosis is unmasked in the great majority of cases&#46; In typical cases&#44; an initial introducer sheath is placed a few centimeters from the anastomosis using an antegrade approach to treat the venous outfow&#46; A catheter is pushed over a wire up to the superior vena cava and then slowly pulled back while contrast medium is injected under fluoroscopy to localize the downstream extension of the thrombosis&#46; The fistula is abandoned at this stage if the venous outflow cannot be traversed or recanalized&#46; A second introducer is placed with a retrograde approach in the direction of the arterial inflow&#46; The fistula is abandoned if it is impossible to traverse the arteriovenous anastomosis with the guidewire&#46; Occasionally&#44; when the stenosis is clinically located a few centimeters from the wrist anastomosis&#44; with no evidence of concomitant outflow stenosis&#44; a single retrograde approach from the vein at the elbow is sufficient to treat the whole fistula&#46; Once access to both the arterial inflow and venous outflow is guaranteed with a guidewire&#44; thombi on the venous side are removed first&#44; before the thrombi on the arterial side&#46; Conventional&#44; high-pressure or cutting balloon angioplasty should be undertaken to remove causative stenotic disease&#46; On completion&#44; both physical examination and fistulogram are performed to visualize the flow from arteriovenous anastomosis to the superior vena cava&#46; Vascular sheaths are removed and haemostasis is achieved by manual compression or using a purse-string suture&#46;<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara">Occasionally&#44; an AVF might clot with minimal or no thrombus&#46; At other times&#44; there is moderate-to-severe thrombus burden that accompanies AVF clotting&#46; While percutaneous balloon angioplasty to correct the underlying stenosis might be all that is needed to declot a fistula with no thrombus&#44; endovascular thromboaspiration is required to successfully declot a fistula with moderate thrombus and surgical referral is advisable in the presence of excessive thrombus burden&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Thrombolysis</span></span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The introduction of mechanical thrombectomy devices has reduced the popularity of thrombolytic therapy&#46; Urokinase&#44; streptokinase&#44; and tissue plasminogen activator &#40;t-PA&#41; have all been used for infusion thrombolysis&#46;<span class="elsevierStyleSup">6&#44;21&#44;22</span> To achieve optimum outcome&#44; anterograde vascular access is obtained as close to the arteriovenous anastomosis as possible&#46; Thrombolytic therapy is then administered via a multiple side hole catheter along the length of the fistula for between 3-24 hours&#44; at doses depending on institutional protocol&#46; To improve outcome&#44; adaptations to the technique have been published&#58; pulse spray thrombolysis&#44; in which highly concentrated fibrinolytic therapy is injected as a high-pressure spray directly into thrombus for 15-20 min&#44; thereby reducing procedural time&#46;<span class="elsevierStyleSup">6</span> Due to modest success rates&#44; thrombolysis is more frequently used in combination with mechanical thrombectomy to maximize clot clearance and reduce procedural times&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Mechanical thrombectomy</span></span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Several methods of mechanical clot dissolution have been published&#46; Balloon thrombectomy was the first published &#8220;purely mechanical&#8221; percutaneous technique used for declotting thtombosed polytetrafluoroethylene grafts&#46;<span class="elsevierStyleSup">23</span> This approach was accomplished using a variety of devices to macerate&#44; dislodge or sweep thrombus from the occluded graft into the central venous circulation&#46; This controversial technique was a milestone in the history of haemodialysis access declotting&#46; From this experience gained in grafts&#44; some teams successfully used this technique of deliberated pulmonary embolizations of clots when the volume of thrombus in the AVF was presumed to be equivalent to the encountered in grafts&#46;<span class="elsevierStyleSup">22</span> Trerotola and colleagues stopped using this technique soon after&#44; when they experiences a casualty&#46;<span class="elsevierStyleSup">8</span> Other casualties have since been reported in the literature&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">A wide range of mechanical thrombectomy devices have been used in the treatment of failed AVFs&#46; The Arrow-Trerotola PTD &#40;Arrow International&#44; Reading&#44; PA&#44; USA&#41; is a rotating nitinol basket available in 5 and 7 F configurations&#46; A handheld battery powered motor results in a basket rotation speed of approximately 3&#44;000rpm&#44; macerating thrombus into particles of 1 to 3mm diameter&#46;<span class="elsevierStyleSup">24&#44;25</span> Thrombus fragments are then aspirated manually using the introducer sheath side port&#46; Simple rotation of a 5 F mini-pigtail catheter &#40;Cook Europe&#44; Bjaeverskov&#44; Denmark&#41; can be used to remove thrombus from occluded AVFs&#46;<span class="elsevierStyleSup">26</span> The Oasis recirculation catheter &#40;Boston Scientific&#47;Medi-Tech&#44; Natick&#44; MA&#41; is available in 6 and 8 F systems and uses a standard angiographic pump injector&#46;<span class="elsevierStyleSup">27</span> The Hydrolyser &#40;Cordis&#44; Miami&#44; FL&#44; USA&#41; is a dual lumen 6 or 7F catheter with a distal side hole and rounded tip and requires the use of a conventional contrast injector to administer saline retrogradely&#46;<span class="elsevierStyleSup">9&#44;28-30</span> The AngioJet catheter &#40;Possis Medical&#44; Minneapolis&#44; MN&#44; USA&#41; is available in 4 to 6F systems uses a specialized pump drive system that creates high pressures&#46;<span class="elsevierStyleSup">14&#44;31</span> The Amplatz thrombectomy device &#40;ATD&#59; Microvena&#44; White Bear Lake&#44; MN&#44; USA&#41; consists of a sharp blade that is rotated at 150&#44;000rpm by a compressed gas driven turbine&#44; within a protective metal capsule&#46; Thrombus is macerated by the rotating blade and dispersed into the bloodstream as microscopic particles&#46;<span class="elsevierStyleSup">15</span> Manual catheter-directed thromboaspiration is a popular technique in France and Spain that uses a straight 7 to 9F end-hole catheter &#40;Guider&#59; Boston Scientific&#44; Natick&#44; MA&#44; USA&#59; or Vista Bright Tip&#59; Cordis&#44; Miami&#44; FL&#44; USA&#41; to remove thrombus by manual suction&#46;<span class="elsevierStyleSup">13&#44;32</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Success</span></p><p class="elsevierStylePara">No single percutaneous thrombectomy technique has been proven to be more efficacious than other methods &#40;Table 1&#41;&#46; Limited data exist regarding outcome of declotting procedures in AVFs using thrombolysis alone&#46; Zaleski&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">22</span>&#160;treated thrombosed AVFs with urokinase thrombolysis and balloon angioplasty and reported a procedural success rate of 82&#37;&#46; Primary patency rate of 64&#37; was achieved at 12 months&#46; Rocek&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">25</span><span class="elsevierStyleSup">&#160;</span>reported a 90&#37; clinical success rate in 10 patients treated using the Arrow-Trerotola PTD&#46; The 6-month primary patency rate was 60&#37;&#46; Shmitz-Rode&#160;et al&#46;<span class="elsevierStyleSup">26</span>&#160;reported 100&#37; clinical success rate in 15 AVFs and 11 grafts using the &#8220;rotating mini-pigtail catheter&#8221;&#44; with a primary patency rate of 47&#37; at 6 months&#46; Sahni&#160;et al&#46;<span class="elsevierStyleSup">27</span>&#160;treated 23 thrombosed accesses &#40;5 AVFs and 17 grafts&#41; using the Oasis catheter with a success rate of 86&#37; and a primary patency rate of 50&#37; at 6 months&#46; Vorwek&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">28</span>&#160;reported a clinical success rate of 85&#37; in 19 clotted AVFs and a primary patency rate of 50&#37; at 12 months using the Hydrolyser catheter&#46; Littler&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">31</span>&#160;published the outcomes of AngioJet thrombectomy in 44 occluded AVFs&#44; with a technical success of 89&#37; and a primary patency rate of 34&#37; at 6 months&#46; Similar results were confirmed by Moossavi&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">14</span>&#46; Recently&#44; Yang&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">33</span> reported a higher success rate using the Arrow-Trerotola PTD&#44; compared to the AngioJet catheter&#46; However&#44; comparable patency rates were obtained at one year of follow-up&#46; A single study examining the clinical outcome of the ATD in occluded AVFs demonstrated a success rate of 89&#37; and a primary patency of 27&#37; at 12 months&#46;<span class="elsevierStyleSup">15</span> Turmel-Rodrigues&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">13</span>&#160;reported the results of manual catheter-directed thromboaspiration technique&#44; with a success rate of 93&#37; for forearm and 76&#37; for upper arm AVFs and a primary patency rate of 49&#37; and 9&#37; in the forearm and upper arm at 12 months&#44; respectively&#46; Similar results were reported by Garc&#237;a Medina&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">32</span><span class="elsevierStyleSup">&#160;</span>and Bizarro&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">34</span>&#46;</p><p class="elsevierStylePara">Intervention studies on thrombosed autogenous fistulae have predominantly appeared after the year 2000&#46; A few have compared endovascular with surgical repair&#44; but none was randomized&#46; The results were comparable with the outcome of endovascular treatment in terms of primary success rate &#40;90&#37;&#160;<span class="elsevierStyleItalic">versus</span>&#160;89&#37;&#41;&#44; but 1-year primary &#40;74&#37;&#160;<span class="elsevierStyleItalic">versus</span>&#160;40&#37;&#41; and secondary patency rates &#40;87&#37;&#160;<span class="elsevierStyleItalic">versus</span>&#160;72&#37;&#41; were higher&#46;<span class="elsevierStyleSup">35</span> However&#44; most studies on surgical thrombectomy of AVFs concerned forearm accesses with the creation of a new&#44; more proximally located arteriovenous anastomosis&#46;<span class="elsevierStyleSup">35-37</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Complications</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The most frequent procedure-related complication associated with angioplasty of the dialysis vascular access is some type of venous rupture&#46; This complication has been reported to represent 70&#8211;75&#37; of all complications&#46;<span class="elsevierStyleSup">38</span> Local complications&#44; such as secondary bleeding and pseudoaneurism from the introducer sheath and vessel injury&#47;disruption do occur in daily clinical practice&#44;<span class="elsevierStyleSup">39</span> but probably are underreported in the literature&#46;</p><p class="elsevierStylePara">There are few significant procedure-related complications&#46; The risk of pulmonary embolism is theoretically greater with autogenous AVFs than with polytetrafluoroethylene grafts&#46;<span class="elsevierStyleSup">40&#44; 41</span> However&#44; clinically silent pulmonary embolism probably occurs in many patients treated by these methods&#46;<span class="elsevierStyleSup">40</span> Arterial embolization can result from clot fragmentation at the arterial anastomosis by catheter or guidewire manipulation&#44; vigorous injection of contrast material&#44; or balloon angioplasty of residual thrombus&#46; However&#44; the reported frequency of arterial embolization has been low &#40;0-7&#37;&#41;&#46;<span class="elsevierStyleSup">42</span> Major hemorrhagic complications requiring additional treatment are reported in 1-7&#37; of cases in these series&#46;<span class="elsevierStyleSup">42</span> Some experts advocate the use of prophylactic antibiotics due to the risk of infection&#46;<span class="elsevierStyleSup">13</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">COSTS</span></p><p class="elsevierStylePara">Probably&#44; no topic has been so underreported in the nephrology literature as the analysis of costs of endovascular procedures for haemodialysis AVF failure&#46; Vascular access costs may account for approximately 10&#37; of the total cost of health care of haemodialysis patient population&#44; with patients dialyzed with a catheter incurring the highest costs&#46;<span class="elsevierStyleSup">43&#44;44</span> It is well known for interventionalists that mechanical thrombectomy devices are expensive &#40;e&#46;g&#46; &#160;Arrow-Trerotola PTD&#44; &#36;600&#59; Hydrolyzer&#44; &#36;600&#59; Oasis&#44; &#36;600&#41;&#46; However&#44; they are not the ones responsible for the high expenditure of endovascular procedures&#46; The amount of resources required for endovascular interventions vary among vascular access centers with different endovascular salvage procedures &#40;Table 2&#41;&#46; Therefore&#44; cost analysis must take into account all the devices employed during the procedure &#40;p&#46;e&#46; guidewires&#44; balloon angioplasty&#44; stents&#41; the pharmacy &#40;e&#46;g&#46; antibiotics&#44; heparin&#44; thrombolytics&#41; and radiology costs &#40;e&#46;g&#46; angiography suite&#44; contrast media&#41;&#44; professional fees and additional overhead expenses&#46;</p><p class="elsevierStylePara">Published findings regarding the economic value of vascular access surveillance revealed that adding access blood flow surveillance to clinical monitoring of grafts and AVFs may reduce thrombosis rates and costs&#46;<span class="elsevierStyleSup">45-47</span> Bittl&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">48</span>&#160;recently reported an economic analysis of angiography and pre-emptive angioplasty to prevent haemodialysis access thrombosis&#46; They observed that pre-emptive angiographic management of malfunctioning nonthrombosed haemodialysis accesses may represent a less efficient use of healthcare resources than increasing the number of patients with AVFs&#46; To our knowledge&#44; cost-effectiveness analyses of endovascular interventions for thrombosed haemodialysis accesses have been performed mainly in patients with clotted prosthetic grafts&#46;<span class="elsevierStyleSup">49-51</span> Sands&#160;et al&#46;<span class="elsevierStyleSup">49</span> performed a retrospective analysis comparing the clinical success and the costs of pharmacomechanical thrombolysis of occluded grafts with surgical thrombectomy&#46; Hospitalization was required for 85&#37; of the cases of surgical thrombectomy and in 17&#37; of cases of pharmacomechanical thrombolysis&#46; Hospital charges and physician costs were obtained for each procedure&#46; Clinical success was similar between lysis and surgical procedures&#46; Hospital&#44; physician and total charges were significantly lower in the lysis group than in the surgical control &#40;US&#36;6&#44;802&#160;<span class="elsevierStyleItalic">versus</span>&#160;US&#36;12&#44;740&#41;&#46; Vesely&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">50</span>&#160;prospectively randomized 20 patients with clotted grafts either to pulse-spray thrombolysis plus angioplasty&#44; or surgical thrombectomy&#46; Thrombolysis and surgical thrombectomy were performed as outpatient procedures in almost of the cases&#46; The technical costs&#44; professional fees&#44; and all other associated costs were obtained&#46; The authors concluded that endovascular thrombolysis and surgical thrombectomy were comparable in cost &#40;US&#36;6&#44;062&#160;<span class="elsevierStyleItalic">versus</span>&#160;US&#36;5&#44;580&#41;&#44; and the technical success and patency rates were also similar&#46; Dougherty&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">51</span>&#160;performed a similar study among 80 patients with clotted grafts&#46; The mean cost of treatment &#40;including room and supply costs but not professional fees&#41; was significantly higher for the endovascular group than for the surgical group &#40;US&#36;2945&#160;<span class="elsevierStyleItalic">versus</span>&#160;US&#36;1512&#41;&#46; In addition&#44; high rate of technical failure necessitating surgery was observed in the endovascular group&#46; To our knowledge&#44; only recently the costs of percutaneous thrombectomy of clotted AVF were reported in the literature&#46;<span class="elsevierStyleSup">34&#44;48</span> Bizarro&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">34 </span>reported a cost analysis of the use of manual catheter-directed thromboaspiration for the treatment of thrombosed AVFs&#46; A comprehensive measurement of total vascular access care-related costs was obtained&#46; The authors reported that the cost of maintenance of thrombosed AVFs by endovascular means was high&#46; The mean total expense of the percutaneous thrombectomy procedure was US&#36;1&#44;381 and for percutaneous transluminal angioplasty was US&#36;785&#46; At one year of follow-up&#44; the mean cumulative cost of vascular access care was US&#36;2&#44;504 per patient-year at risk&#46; The mean cost was greatest for patients with brachiocephalic AVFs &#40;US&#36;3&#44;578&#41; than for patients with forearm AVFs &#40;US&#36;1&#44;604&#41;&#46; In comparison&#44; in the Bittl&#160;et al<span class="elsevierStyleItalic">&#46;</span>&#160;study<span class="elsevierStyleSup">48</span>&#160;procedure costs were approximately two times higher &#40;angioplasty&#44; US&#36;1&#44;939&#59; percutaneous thrombectomy&#44; US&#36;3&#44;361&#41;&#46; Possible explanations for the differences observed in these two studies are&#58; &#40;a&#41; in the first study&#44;<span class="elsevierStyleSup">34</span> the investigators used manual catheter-directed thromboaspiration technique whereas Bittl&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">48</span> used the AngioJet catheter for thrombosed AVFs&#59; &#40;b&#41; stents were not used in the first study&#44;<span class="elsevierStyleSup">34</span> whereas Bittl&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">48</span>&#160;placed stents for several indications and&#59; &#40;c&#41; physician billing differ among countries&#46;<span class="elsevierStyleSup">52</span></p><p class="elsevierStylePara">Percutaneous thrombectomy is an effective policy to treat thrombosed failed AVFs&#46; Yes&#44; but an expensive one&#46; Do we&#44; nephrologists&#44; have other cost-effective approaches to deal with failed AVF&#63; Does surgical thrombectomy may overcome the high financial burden of percutaneous thrombectomy&#44; with similar success rates&#63; Does the abandon of failed AVFs toward the creation of a new permanent accesss still an option&#63; To our knowledge&#44; clear-cut data has not been published answering these questions&#46; Recenlty&#44; Miller&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">5</span>&#160;evaluated the efficacy&#44; functionality&#44; and cost associated with the use of percutaneous techniques for the salvage of thrombosed immature fistulae&#46; All fistulae had thrombosed following access creation and had never been used for haemodialysis&#46; The authors concluded that endovascular techniques yield significant cost savings over access abandonment&#46; Coentr&#227;o&#160;et al<span class="elsevierStyleItalic">&#46;</span><span class="elsevierStyleSup">53</span>&#160;compared two distinct policies for the maintenance of vascular access in prevalent haemodiaysis patients with thrombosed AVFs&#58; percutaneous thrombectomy&#160;<span class="elsevierStyleItalic">versus</span>&#160;central venous catheterization to bridge the interval until a new AVF is suitable for cannulation&#46; The authors observed that AVF salvage by endovascular therapy led to a near two-fold reduction in access-related expenses&#59; the added costs associated with the procedure itself was completely offset by the saving associated with lower surgical visits&#44; access dysfunction&#44; and hospitalizations&#46;</p><p class="elsevierStylePara">Taking into consideration the published high success rates and the costs of percutaneous thrombectomy of occluded autogenous fistulae&#44; nephrologists&#44; Medical Societies and National Health Services face a new era of vascular access care&#46; If the final decision is to treat failed AVFs&#44; intensive efforts should be undertaken to universalize these interventions&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Key concept</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Several studies have reported on the feasibility and relatively high-clinical success rate of the endovascular approach to thrombosed autogenous arteriovenous fistulae in recent years&#46; However&#44; maintenance of a previously thrombosed arteriovenous fistulae require repeated interventions and thus could be a highly expensive policy&#46; Further prospective cost-effectiveness analyses comparing different thrombectomy procedures &#40;endovascular&#160;<span class="elsevierStyleItalic">versus</span>&#160;surgery&#41; and distinct approaches for the maintenance of functional autogenous fistulae &#40;pre-emptive angioplasty&#160;<span class="elsevierStyleItalic">versus</span>&#160;percutaneous thrombectomy&#41; need to be carried out&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflict of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11725&#95;16025&#95;41407&#95;en&#95;t111725&#95;02&#95;maquetacin&#95;1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11725_16025_41407_en_t111725_02_maquetacin_1.jpg" alt="Results of dialysis autogenous arteriovenous fistula &#40;AVF&#41; declotting procedures"></img></a></p><p class="elsevierStylePara">Table 1&#46; Results of dialysis autogenous arteriovenous fistula &#40;AVF&#41; declotting procedures</p><p class="elsevierStylePara"><a href="grande&#47;11725&#95;16025&#95;41408&#95;en&#95;t211725&#95;02&#95;maquetacin&#95;1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11725_16025_41408_en_t211725_02_maquetacin_1.jpg" alt="Costs of endovascular procedures for dysfunctional and thrombosed haemodialysis autogenous arteriovenous fistula &#40;AVF&#41; and polytetrafluoroethylene graft &#40;PTFE&#41;"></img></a></p><p class="elsevierStylePara">Table 2&#46; Costs of endovascular procedures for dysfunctional and thrombosed haemodialysis autogenous arteriovenous fistula &#40;AVF&#41; and polytetrafluoroethylene graft &#40;PTFE&#41;</p>"
    "pdfFichero" => "P1-E557-S4293-A11725-EN.pdf"
    "tienePdf" => true
    "PalabrasClave" => array:2 [
      "es" => array:6 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440115"
          "palabras" => array:1 [
            0 => "An&#225;lisis de costo"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440117"
          "palabras" => array:1 [
            0 => "An&#225;lisis econ&#243;mico"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440119"
          "palabras" => array:1 [
            0 => "F&#237;stula arteriovenosa aut&#243;loga"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440121"
          "palabras" => array:1 [
            0 => "Trombectom&#237;a percut&#225;nea"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440123"
          "palabras" => array:1 [
            0 => "Di&#225;lisis"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec440125"
          "palabras" => array:1 [
            0 => "Tratamiento endovascular"
          ]
        ]
      ]
      "en" => array:6 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440116"
          "palabras" => array:1 [
            0 => "Cost analysis"
          ]
        ]
        1 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440118"
          "palabras" => array:1 [
            0 => "Economic analysis"
          ]
        ]
        2 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440120"
          "palabras" => array:1 [
            0 => "Autogenous arteriovenous fistulae"
          ]
        ]
        3 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440122"
          "palabras" => array:1 [
            0 => "Percutaneous thrombectomy"
          ]
        ]
        4 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440124"
          "palabras" => array:1 [
            0 => "Dialysis"
          ]
        ]
        5 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec440126"
          "palabras" => array:1 [
            0 => "Endovascular treatment"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<p class="elsevierStylePara">El acceso vascular funcional es un requisito previo para el tratamiento renal sustitutivo en pacientes con enfermedad renal cr&#243;nica&#46; Las f&#237;stulas aut&#243;logas se consideran superiores a las pr&#243;tesis vasculares y los cat&#233;teres venosos centrales&#59; sin embargo&#44; las f&#237;stulas no est&#225;n exentas de problemas&#46; Las trombosis de la f&#237;stula aut&#243;loga se han convertido en un reto en la pr&#225;ctica cl&#237;nica de nefrolog&#237;a&#44; con importantes implicaciones cl&#237;nicas para pacientes en di&#225;lisis&#46; Varios estudios han informado sobre la viabilidad y la tasa relativamente alta del &#233;xito cl&#237;nico del abordaje endovascular de f&#237;stulas trombosadas en los &#250;ltimos a&#241;os&#46; Sin embargo&#44; como las repetidas intervenciones suelen ser necesarias para lograr la supervivencia a largo plazo del acceso&#44; el mantenimiento de una f&#237;stula anteriormente trombosada podr&#237;a ser una pol&#237;tica muy cara&#46; Los objetivos de este art&#237;culo son proporcionar al lector una idea de los m&#250;ltiples enfoques endovasculares para f&#237;stulas aut&#243;logas trombosadas&#44; teniendo en cuenta su eficacia cl&#237;nica y las implicaciones financieras&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<p class="elsevierStylePara">Functional vascular access is a prerequisite for adequate haemodialysis treatment in patients with end-stage renal disease&#46; Autogenous arteriovenous fistulae are considered superior to synthetic grafts and central venous catheters&#59; however&#44; fistulae are not without problems&#46; Fistulae thrombosis has become a clinical challenge in nephrology practice&#44; with relevant clinical implications for dialysis patients&#46; Several studies have reported on the feasibility and relatively high-clinical success rate of the endovascular approach to thrombosed fistulae in recent years&#46; However&#44; as repeated interventions are usually required to achieve long-term access survival&#44; maintenance of a previously thrombosed fistulae could be a highly expensive policy&#46; The goals of this article are to provide the reader an insight into the multiple endovascular approaches for thrombosed arteriovenous fistulae&#44; bearing in mind its clinical effectiveness and financial implications&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:8 [
        "identificador" => "fig1"
        "etiqueta" => "Tab.  1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11725_16025_41407_en_t111725_02_maquetacin_1.jpg"
            "Alto" => 715
            "Ancho" => 2167
            "Tamanyo" => 495312
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Results of dialysis autogenous arteriovenous fistula &#40;AVF&#41; declotting procedures"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig2"
        "etiqueta" => "Tab.  2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "copyright" => "Elsevier Espa&#241;a"
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "11725_16025_41408_en_t211725_02_maquetacin_1.jpg"
            "Alto" => 692
            "Ancho" => 2158
            "Tamanyo" => 330772
          ]
        ]
        "descripcion" => array:1 [
          "en" => "Costs of endovascular procedures for dysfunctional and thrombosed haemodialysis autogenous arteriovenous fistula &#40;AVF&#41; and polytetrafluoroethylene graft &#40;PTFE&#41;"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:53 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tordoir J, Canaud B, Haage P, Konner K,\u{A0}Basci A,\u{A0}Fouque D,\u{A0}et al. EBPG on vascular access. Nephrol Dial Transplant 2007;22 Suppl 2:ii88-ii117."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vascular\u{A0}Access\u{A0}2006 Work Group.\u{A0}KDOQI: Clinical practice guidelines and clinical practice recommendations for vascular access. Am J Kidney Dis 2006;48: S176-S247. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16813989" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "SwanTL, Smyth SH, Ruffenbach SJ, Berman SS, Pond GD. Pulmonary embolism following hemodialysis access thrombolysis/thrombectomy. J Vasc Interv Radiol 1995;6:683-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8541667" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Trerotola SO, Johnson MS, Schauwecker DS, Davidson DD,\u{A0}Filo RS,\u{A0}Zhou XH,\u{A0}et al. Pulmonary emboli from pulse-spray and mechanical thrombolysis: evaluation with an animal diaysis-graft model. Radiology 1996;200:169-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8657906" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Miller GA, Hwang W, Preddie D, Khariton A,\u{A0}Savransky Y. Percutaneous salvage of thrombosed immature arteriovenous fistulas. Semin Dial 2011;24:107-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21338402" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Valji K, Bookstein JJ, Roberts AC, Oglevie SB,\u{A0}Pittman C,\u{A0}O'Neill MP.\u{A0}Pulse-spray pharmacomechanical thrombolysis of thrombosed hemodialysis access grafts: comparison of original and current techniques. AJR Am J Roentgenol 1995;165:1495-500."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Beathard GA, Welch BR, Maidment HJ. Mechanical thrombolysis for the treatment of thrombosed hemodialysis grafts. Radiology 1996;200:711-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8756920" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Trerotola SO, Vesely TM, Lung GB, Soulen MC,\u{A0}Ehrman KO,\u{A0}Cardella JF. Treatment of thrombosed hemodialysis access grafts: Arrow-Trerotola percutaneous thrombolytic device versus pulse-spray thrombolysis. Radiology 1998;206:403-14. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9457193" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vorwerk D,\u{A0}Schurmann K,\u{A0}Müller-Leisse C,\u{A0}Adam G,\u{A0}Bücker A,\u{A0}Sohn M, et al. Hemodynamic thrombectomy of haemodialysis grafts and fistulae: results of 51 procedures. Nephrol Dial Transplant 1996;11:1058-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8671969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Uflacker R, Rajagopalan PR, Vujic I, Stutley JE. Treatment of thombosed dialysis access grafts: randomized trial of surgical thrombectomy versus mechanical thrombectomy with the amplatz device. J Vasc\u{A0} Interv Radiol 1996;7:185-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9007796" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vesely TM,\u{A0}Williams D,\u{A0}Weiss M,\u{A0}Hicks M,\u{A0}Stainken B,\u{A0}Matalon T, et al. Comparison of the AngioJet rheolytic catheter to surgical thrombectomy for the treatment of thrombosed hemodialysis grafts. J Vasc Interv Radiol 1999;10:1195-205. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10527197" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Turmel-Rodrigues L,\u{A0}Sapoval M,\u{A0}Pengloan J,\u{A0}Billaux L,\u{A0}Testou D,\u{A0}Hauss S, et al. Manual thromboaspiration and dilation of thrombosed dialysis access: Mid-term results of a simple concept. J Vasc Interv Radiol 1997;8:813-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9314373" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Turmel-Rodrigues L,\u{A0}Pengloan J,\u{A0}Rodrigue H,\u{A0}Brillet G,\u{A0}Lataste A,\u{A0}Pierre D, et al. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int 2000;57:1124-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10720965" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Moossavi S, Regan JD, Pierson ED, Kasey JM, Tuttle AB, Vachharajani TJ, et al. Nonsurgical salvage of thrombosed arterio-venous fistulae: A case series and review of the literature. Semin Dial 2007;20:459-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17897255" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Haage P, Vorwerk D, Wilberger JE, Piroth W,\u{A0}Schürmann K,\u{A0}Günther RW. Percutaneous treatment of thrombosed primary arteriovenous hemodialysis access fistulae. Kidney Int 2000;57:1169-75. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10720969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Liang HL,\u{A0}Pan HB,\u{A0}Chung HM,\u{A0}Ger LP,\u{A0}Fang HC,\u{A0}Wu TH, et al. Restoration of thrombosed Brescia-Cimino dialysis fistulas by using percutaneous transluminal angioplasty. Radiology 2002;223:339-44. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11997535" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rajan DK,\u{A0}Clark TW,\u{A0}Simons ME,\u{A0}Kachura JR,\u{A0}Sniderman K. Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas. J Vasc Interv Radiol 2002;13:1211-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12471184" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shatsky JB, Berns JS, Clark TW, Kwak A,\u{A0}Tuite CM,\u{A0}Shlansky-Goldberg RD,\u{A0}et al. Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol 2005;16:1605-11. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16371525" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jain G, Maya ID, Allon M. Outcomes of percutaneous mechanical thrombectomy of arteriovenous fistulas in hemodialysis patients. Semin Dial 2008;21:581-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19000116" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vorwerk D,\u{A0}Konner K,\u{A0}Schürmann K,\u{A0}Günther RW. A simple trick to facilitate bleeding control after percutaneous hemodialysis fistula and graft interventions. Cardiovasc Intervent Radiol 1997;20:159-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9030511" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109708021165"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Klimas VA,\u{A0}Denny KM,\u{A0}Paganini EP,\u{A0}Graor RA,\u{A0}Nakamoto S,\u{A0}Risius B, et al. Low dose streptokinase therapy for thrombosed arteriovenous fistulas. Trans Am Soc Artif Intern Organs 1984;30:511-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6533933" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Zaleski GX,\u{A0}Funaki B,\u{A0}Kenney S,\u{A0}Lorenz JM,\u{A0}Garofalo R. Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas. J Vasc Interv Radiol 1999;10:129-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10082098" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Trerotola SO,\u{A0}Lund GB,\u{A0}Scheel PJ Jr,\u{A0}Savader SJ,\u{A0}Venbrux AC,\u{A0}Osterman FA Jr. Thrombosed dialysis access grafts: percutaneous mechanical declotting without urokinase. Radiology 1994;191:721-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8184052" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Trerotola SO,\u{A0}McLennan G,\u{A0}Davidson D,\u{A0}Lane KA,\u{A0}Ambrosius WT,\u{A0}Lazzaro C,\u{A0}et al. Preclinical in vivo testing of the Arrow-Trerotola percutaneous thrombolytic device for venous thrombosis. J Vasc Interv Radiol 2001;12:95-103. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11200360" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rocek M,\u{A0}Peregrin JH,\u{A0}Lasovicková J,\u{A0}Krajícková D,\u{A0}Slavíoková M. Mechanical thrombolysis of thrombosed hemodialysis native fistulas with use of the Arrow-Trerotola percutaneous thrombolytic device: our preliminary experience. J Vasc Interv Radiol 2000;11:1153-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11041471" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schmitz-Rode T,\u{A0}Wildberger JE,\u{A0}Hübner D,\u{A0}Wein B,\u{A0}Schürmann K,\u{A0}Günther RW. Recanalization of thrombosed dialysis access with use of a rotating mini-pigtail catheter: follow-up study. J Vasc Interv Radiol 2000;11:721-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10877416" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sahni V,\u{A0}Kaniyur S,\u{A0}Malhotra A,\u{A0}Fan S,\u{A0}Blakeney C,\u{A0}Fotheringham T, et al. Mechanical thrombectomy of occluded hemodialysis native fistulas and grafts using a hydrodynamic thrombectomy catheter: preliminary experience. Cardiovasc Intervent Radiol 2005;28:714-21. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16059764" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vorwerk D,\u{A0}Schurmann K,\u{A0}Müller-Leisse C,\u{A0}Adam G,\u{A0}Bücker A,\u{A0}Sohn M, et al. Hydrodynamic thrombectomy of haemodialysis grafts and fistulae: results of 51 procedures. Nephrol Dial Transplant 1996;11:1058-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8671969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Overbosch EH,\u{A0}Pattynama PM,\u{A0}Aarts HJ,\u{A0}Schultze Kool LJ,\u{A0}Hermans J,\u{A0}Reekers JA. Occluded hemodialysis shunts: Dutch multicenter experience with the hydrolyser catheter. Radiology 1996;201:485-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8888246" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rousseau H,\u{A0}Sapoval M,\u{A0}Ballini P,\u{A0}Dube M,\u{A0}Joffre F,\u{A0}Gaux JC, et al. Percutaneous recanalization of acutely thrombosed vessels by hydrodynamic thrombectomy (Hydrolyser). Eur Radiol 1997;7:935-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9228112" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Littler P,\u{A0}Cullen N,\u{A0}Gould D,\u{A0}Bakran A,\u{A0}Powell S. AngioJet thrombectomy for occluded dialysis fistulae: outcome data. Cardiovasc Intervent Radiol 2009;32:265-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19115071" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109711014884"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "García Medina J,\u{A0}Lacasa Pérez N,\u{A0}Muray Cases S,\u{A0}Pérez Garrido I,\u{A0}García Medina V. Accesos vasculares para hemodiálisis trombosados: rescate mediante técnicas de radiología vascular intervencionista. Nefrologia 2009;29:249-55. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19554059" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yang CC, Yang CW, Wen SC, Wu CC. Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas. Catheter Cardiovasc Interv 2012;80(6):1035-41. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22511560" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bizarro P,\u{A0}Coentrão L,\u{A0}Ribeiro C,\u{A0}Neto R,\u{A0}Pestana M. Endovascular treatment of thrombosed dialysis fistulae: a cumulative cost analysis. Catheter Cardiovasc Interv. 2011;77:1065-1070. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21413132" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tordoir JH,\u{A0}Bode AS,\u{A0}Peppelenbosch N,\u{A0}van der Sande FM,\u{A0}de Haan MW. Surgical or endovascular repair of thrombosed dialysis vascular access: Is there any evidence? J Vasc Surg 2009;50:953-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19786244" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ponikvar R. Surgical salvage of thrombosed arteriovenous fistulas and grafts. Ther Apher Dial 2005;9:245-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15966999" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lipari G,\u{A0}Tessitore N,\u{A0}Poli A,\u{A0}Bedogna V,\u{A0}Impedovo A,\u{A0}Lupo A, et al. Outcomes of surgical revision of stenosed and thrombosed forearm arteriovenous fistulae for haemodialysis. Nephrol Dial Transplant 2007;22:2605-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17517799" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Beathard GA, Urbanes A, Litchfield A. The classification of procedure related complications-a fresh approach. Semin Dial 2006;19:527-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17150055" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Renaud CJ,\u{A0}Lopes K,\u{A0}Bourquelot P,\u{A0}Turmel-Rodrigues L. Skin and venous rupture at a hemodialysis needle cannulation site during angioplasty of a transposed forearm fistula. J Vasc Interv Radiol\u{A0} 2011;22:1488-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21961984" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dolmatch BL, Gray RJ, Horton KM. Will iatrogenic pulmonary embolization be our pulmonary embarrassment? Radiology 1994;191:615-7."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Swan TL,\u{A0}Smyth SH,\u{A0}Ruffenach SJ,\u{A0}Berman SS,\u{A0}Pond GD. Pulmonary embolism following hemodialysis access thrombolysis/thrombectomy. J Vasc Interv Radiol 1995;6:683-86."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Valji K. Transcatheter treatment of thrombosed hemodialysis access grafts. AJR Am J Roentgenol 1995;164:823-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7726032" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "USRDS: The economic cost of ESRD, vascular access procedures, and medicare spending for alternative modalities of treatment. Am J Kidney Dis 1997;30:S160-S177. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9259700" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Amedia CA Jr,\u{A0}Bolton WK,\u{A0}Cordray T,\u{A0}Hakim R,\u{A0}Howard R,\u{A0}Jackson J, et al. Vascular access for HD: aligning payment with quality. Semin Dial 2011;24:37-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21338392" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Tessitore N,\u{A0}Bedogna V,\u{A0}Poli A,\u{A0}Mantovani W,\u{A0}Lipari G,\u{A0}Baggio E, et al. Adding access blood flow surveillance to clinical monitoring reduces thrombosis rates and costs, and improves fistula patency in the short term: A controlled cohort study. Nephrol Dial Transplant 2008;23:3578-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18511608" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "McCarley P,\u{A0}Wingard RL,\u{A0}Shyr Y,\u{A0}Pettus W,\u{A0}Hakim RM,\u{A0}Ikizler TA. Vascular access blood flow monitoring reduces access morbidity and costs. Kidney Int 2001;60:1164-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11532113" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Wijnen E,\u{A0}Planken N,\u{A0}Keuter X,\u{A0}Kooman JP,\u{A0}Tordoir JH,\u{A0}de Haan MW,\u{A0}et al. Impact of a quality improvement programme based on vascular access flow monitoring on costs, access occlusion and access failure. Nephrol Dial Transplant 2006;21:3514-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16921189" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bittl JA, Cohen DJ, Seek MM, Feldman RL. Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis access thrombosis. Catheter Cardiovasc Interv 2010;75:14-21. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19862805" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0085253815536491"
                          "estado" => "S300"
                          "issn" => "00852538"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sands JJ, Patel S, Plaviak DJ, Miranda CL. Pharmacomechanical thrombolysis with urokinase for treatment of thrombosed hemodialysis access grafts. ASAIO J 1994;40:M886-M888. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8555639" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vesely TM,\u{A0}Idso MC,\u{A0}Audrain J,\u{A0}Windus DW,\u{A0}Lowell JA, et al. Thrombolysis versus surgical thrombectomy for the treatment of dialysis graft thrombosis: Pilot study comparing costs. J Vasc Interv Radiol 1996;7:507-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8855526" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dougherty MJ,\u{A0}Calligaro KD,\u{A0}Schindler N,\u{A0}Raviola CA,\u{A0}Ntoso A. Endovascular versus surgical treatment for thrombosed hemodialysis grafts: A prospective, randomized study. J Vasc Surg 1999;30:1016-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10587385" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "World Bank: World Development Indicators 2000. Washington DC: World Bank; 2001."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Coentrão L, Bizarro P, Ribeiro C, Neto R, Pestana M. Percutaneous treatment of thrombosed arteriovenous fistulas: clinical and economic implications. Clin J Am Soc Nephrol 2010;5:2245-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20798249" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052928/v0_201502091630/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "35445"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Short Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000004/v0_201502091629/X2013251413052928/v0_201502091630/en/P1-E557-S4293-A11725-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052928?idApp=UINPBA000064"
]

Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2013.Feb.11725

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	6	11	17
2024 October	70	48	118
2024 September	128	47	175
2024 August	104	71	175
2024 July	64	71	135
2024 June	80	41	121
2024 May	105	44	149
2024 April	92	53	145
2024 March	76	44	120
2024 February	77	58	135
2024 January	66	38	104
2023 December	70	40	110
2023 November	67	59	126
2023 October	61	40	101
2023 September	79	36	115
2023 August	73	36	109
2023 July	50	31	81
2023 June	57	22	79
2023 May	91	31	122
2023 April	70	18	88
2023 March	132	19	151
2023 February	63	30	93
2023 January	57	29	86
2022 December	50	26	76
2022 November	48	31	79
2022 October	64	51	115
2022 September	50	34	84
2022 August	68	48	116
2022 July	39	43	82
2022 June	47	30	77
2022 May	39	28	67
2022 April	60	51	111
2022 March	73	46	119
2022 February	75	39	114
2022 January	80	43	123
2021 December	70	42	112
2021 November	56	31	87
2021 October	81	41	122
2021 September	51	32	83
2021 August	67	55	122
2021 July	37	38	75
2021 June	40	22	62
2021 May	40	24	64
2021 April	77	38	115
2021 March	62	30	92
2021 February	59	24	83
2021 January	45	20	65
2020 December	31	19	50
2020 November	35	23	58
2020 October	27	13	40
2020 September	28	16	44
2020 August	32	12	44
2020 July	41	8	49
2020 June	53	21	74
2020 May	57	19	76
2020 April	43	25	68
2020 March	54	16	70
2020 February	62	37	99
2020 January	75	23	98
2019 December	89	23	112
2019 November	83	25	108
2019 October	63	20	83
2019 September	110	30	140
2019 August	72	20	92
2019 July	75	31	106
2019 June	60	19	79
2019 May	48	21	69
2019 April	92	41	133
2019 March	60	19	79
2019 February	46	18	64
2019 January	49	19	68
2018 December	139	33	172
2018 November	131	15	146
2018 October	108	27	135
2018 September	115	16	131
2018 August	74	16	90
2018 July	79	16	95
2018 June	77	9	86
2018 May	71	18	89
2018 April	75	7	82
2018 March	94	16	110
2018 February	71	8	79
2018 January	74	10	84
2017 December	57	9	66
2017 November	103	10	113
2017 October	78	10	88
2017 September	70	15	85
2017 August	95	47	142
2017 July	91	26	117
2017 June	83	26	109
2017 May	91	28	119
2017 April	79	26	105
2017 March	115	26	141
2017 February	145	36	181
2017 January	74	20	94
2016 December	104	10	114
2016 November	146	15	161
2016 October	203	11	214
2016 September	334	4	338
2016 August	510	9	519
2016 July	333	11	344
2016 June	203	0	203
2016 May	223	0	223
2016 April	161	0	161
2016 March	149	0	149
2016 February	161	0	161
2016 January	154	0	154
2015 December	183	0	183
2015 November	127	0	127
2015 October	100	0	100
2015 September	124	0	124
2015 August	104	0	104
2015 July	131	0	131
2015 June	65	0	65
2015 May	55	0	55
2015 April	7	0	7

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter