{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:55:31Z","timestamp":1790920531125,"version":"4.1.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"\n Purpose<\/jats:title>\n To compare single session (SS) versus extended infusion (EI) catheter-directed thrombolysis (CDT) combined with PTA for acute AVG thrombosis, with allocation based on thrombus burden and lesion morphology.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This study included hemodialysis patients with acute AVG thrombosis treated between April 2020 and September 2023. All patients underwent angiographic classification of AVG stenosis\/occlusion into two morphological types: Type I (isolated venous anastomotic stenosis\/occlusion) and Type II (complex, multi-segment occlusion involving the arterial anastomosis, graft lumen, and\/or venous anastomosis). Based on this classification and thrombus burden assessment, patients with Type I lesions or low thrombus burden received SS-CDT\u2009+\u2009PTA, while those with Type II lesions or high thrombus burden received EI-CDT\u2009+\u2009PTA. The primary endpoint was primary patency. Secondary endpoints included technical success rate, procedure-related complications, and secondary patency. Kaplan\u2013Meier survival analysis and multivariate Cox proportional hazards regression were performed. A shared-frailty model and patient-level sensitivity analysis were used to account for within-patient clustering.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 105 procedures in 89 patients were analyzed (SS-CDT,\n n<\/jats:italic>\n \u2009=\u200973; EI-CDT,\n n<\/jats:italic>\n \u2009=\u200932). Median primary patency was comparable: SS-CDT 183 days vs. EI-CDT 183 days (log-rank\n p<\/jats:italic>\n \u2009=\u20090.867). The proportion of Type II lesions was 80.8% (59\/73) in the SS-CDT group and 90.6% (29\/32) in the EI-CDT group (\n p<\/jats:italic>\n \u2009=\u20090.261). On multivariate Cox regression, graft age &gt;24 months was associated with improved patency (HR 0.59,\n p<\/jats:italic>\n \u2009=\u20090.023), while Type II morphology (HR 0.80,\n p<\/jats:italic>\n \u2009=\u20090.428) and CDT protocol (HR 0.91,\n p<\/jats:italic>\n \u2009=\u20090.79). Technical success was 100% in both groups (excluding 7 crossover procedures). One major complication (septic shock) occurred in the EI-CDT group. Minor complications were comparable, except puncture-site bleeding (EI-CDT: 18.8% vs. SS-CDT: 0%,\n p<\/jats:italic>\n \u2009&lt;\u20090.001). Urokinase infusion was interrupted in 2 EI-CDT procedures due to bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Patency outcomes were not significantly influenced by CDT protocol duration or lesion morphology, suggesting that the stratified treatment approach effectively equalized outcomes across clinical contexts; notably, graft age &gt;24 months was independently associated with improved primary patency (HR 0.59,\n p<\/jats:italic>\n \u2009=\u20090.023), a finding most plausibly reflecting survivor-graft bias rather than a true treatment effect.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1919383","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T05:36:10Z","timestamp":1790919370000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Thrombus burden-stratified catheter-directed thrombolysis combined with percutaneous transluminal angioplasty for acute arteriovenous graft thrombosis in hemodialysis patients: a comparison of single-session versus extended infusion protocols"],"prefix":"10.3389","volume":"13","author":[{"given":"Bin","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Interventional Radiology, Hui Ya Hospital of The First Affiliated Hospital of Sun Yat-Sen University","place":["Huizhou, China"]},{"name":"Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keyu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyuan","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Run","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haitao","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-Sen University","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Interventional 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