Study of thrombus from thrombosed hemodialysis access grafts.
OBJECTIVE
To determine the volume and composition of clot within thrombosed hemodialysis access grafts.


METHODS
Clots were collected in 22 patients at surgical thrombectomy of polytetrafluoroethylene grafts. Histologic analysis was performed in 10 of these clots plus 21 randomly selected clots from the pathology archives.


RESULTS
A small, firm piece of whitish thrombus ("arterial plug") was almost always recovered from the arterial limb of the graft. This plug had a concave surface and ranged from 5 mm to 3 cm in length. The remaining clot was soft, red thrombus. The mean weight of all clots was 3.4 g, and mean volume was 3.2 cm3. Average graft length was 42 cm. Histologically, the arterial plug had a characteristic appearance of densely compacted alternating layers of erythrocytes and fibrin.


CONCLUSIONS
Clot volume in thrombosed dialysis grafts is much less (approximately equal to 25%) than would be expected if the graft were completely filled with thrombus, a finding of significance to mechanical thrombolytic techniques. Resistance of the arterial plug to pulse-spray thrombolysis is likely due to compaction.
D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation; D001672:Biocompatible Materials; D001792:Blood Platelets / Q000473:pathology / Q000648:ultrastructure; D001916:Brachial Artery / Q000601:surgery; D002408:Catheters, Indwelling; D003116:Color; D004912:Erythrocytes / Q000473:pathology; D005337:Fibrin; D006801:Humans; D007962:Leukocytes / Q000473:pathology; D011138:Polytetrafluoroethylene; D011655:Pulmonary Embolism / Q000517:prevention & control; D006435:Renal Dialysis / Q000295:instrumentation*; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000473:pathology* / Q000517:prevention & control; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D014680:Veins / Q000601:surgery
D001672:Biocompatible Materials; D005337:Fibrin; D011138:Polytetrafluoroethylene; D014568:Urokinase-Type Plasminogen Activator