[In situ fibrinolysis of acute arteriovenous shunt obstructions during hemodialysis].
Several techniques (surgical revision, thrombectomy, ...) have been described for the treatment of thrombosed vascular access (VA) in hemodialysis patients. We propose a technique with local thrombolytic infusion in conjunction with angiography and percutaneous dilatation and/or recanalization. A total of fourteen patients with twenty-two episodes of thrombosed VA was studied. Eleven patients had a Brescia-Cimino fistula and three patients had a graft fistula. We used in 21 cases urokinase (243000 UI +/- 100000 UI) and in 1 case rt-PA (50 mg). Of the 22 VA, 19 issued in an immediate patency and were restored to full function; and whereof 17 remained patent more than 2 weeks. Failures occurred in 3 cases: localized bleeding from previous dialysis puncture sites (1), venous outflow obstruction (1), and resistant venous stenosis (1). There were no infectious complications, and no systemic bleeding complications. We observed one pseudoaneurysm and one humeral asymptomatic thrombo-embolism. Stenoses were the most frequent factor in precipitating thrombosis. We believe that our technique should be the first line of treatment of occluded hemodialysis vascular access.
Jahn
C
C
Service de Radiologie, Chirurgie A, ULP Strasbourg.
Lebras
Y
Y
Mutter
D
D
Petitjean
P
P
Roy
C
C
Schnitzler
B
B
Dimitrov
Y
Y
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001367:Axillary Vein; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D003251:Constriction, Pathologic; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D011994:Recombinant Proteins; D011138:Polytetrafluoroethylene; D006493:Heparin; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator
Fibrinolyse in situ des oblitérations aiguës des fistules artério-veineuses chez les hémodialysés.