Thrombosed dialysis access grafts: percutaneous mechanical declotting without urokinase.
OBJECTIVE
To evaluate percutaneous declotting of dialysis access grafts with available catheters without urokinase.


METHODS
Thirty-four clotted grafts were treated in 24 patients. Clot was macerated and pushed into the central circulation with balloon catheters.


RESULTS
Successful mechanical declotting was performed in all but two patients (94%). The procedure was abandoned after successful declotting in four patients with poor venous outflow, resulting in a 24-hour success rate of 82%. Mean total procedure time was 116 minutes. Eight grafts clotted within 1 week. Using successful dialysis beyond 1 week as the measure of clinical success, the authors report a 59% clinical success rate with mean primary patency of 126 days (range, 16-322 days). Two complications, both emboli to the brachial artery, were successfully treated with urokinase. No symptomatic pulmonary emboli occurred.


CONCLUSIONS
Mechanical thrombolysis of clotted grafts with currently available catheters yields results similar to those reported with mechanical devices and urokinase. The procedure is relatively inexpensive, safe, and well tolerated.
Trerotola
S O
SO
Department of Radiology, University Hospital, Indiana University Medical Center, Indianapolis 46202-5253.
Lund
G B
GB
Scheel
P J
PJ
Savader
S J
SJ
Venbrux
A C
AC
Osterman
F A
FA
D000328:Adult; D000368:Aged; D001132:Arm / Q000098:blood supply; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation; D004617:Embolism / Q000209:etiology; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D015641:Radiography, Interventional; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D017131:Thrombectomy / Q000379:methods; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D014568:Urokinase-Type Plasminogen Activator