Recurrent thrombosis of polytetrafluoroethylene dialysis fistulas after recent surgical thrombectomy: salvage by means of thrombolysis and angioplasty.
OBJECTIVE
To test the hypothesis that thrombolysis followed by angioplasty for salvage of thrombosed polytetrafluoroethylene (PTFE) dialysis fistulas is safe and effective even after recent surgical thrombectomy.


METHODS
Thrombolysis and balloon angioplasty were performed on 12 fistulas in which thrombosis had recurred within 30 days after thrombectomy (n = 10) or thrombectomy/revision (n = 2). All patients underwent pulse-spray pharmacomechanical thrombolysis with urokinase and use of a crossed-catheter technique. A total of 250,000-1,000,000 IU of urokinase and 2,500 IU of heparin were injected throughout the clot in 17-33 minutes. A bolus of 2,500 IU of heparin was simultaneously administered intravenously.


RESULTS
Thrombolysis was successful in restoring flow in all grafts, but thrombosis recurred in three grafts before they could be used for dialysis. The clinical success rate was thus 75%. There were no major complications. Mean primary patency after thrombolysis in this small select group of patients was 94 days (median, 68.5 days), comparing favorably with the mean patency of 44 days (median, 23 days) achieved by the prior 23 surgical revisions in the same grafts.


CONCLUSIONS
Percutaneous fistula salvage appears to be a safe and effective means of treating recurrent thrombosis in PTFE dialysis fistulas when recent surgical thrombectomy has failed.
Berger
M F
MF
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Aruny
J E
JE
Skibo
L K
LK
D017130:Angioplasty; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D003131:Combined Modality Therapy; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D012008:Recurrence; D006435:Renal Dialysis; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000628:therapy*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014654:Vascular Patency
D011138:Polytetrafluoroethylene; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator