title: Pulse-spray pharmacomechanical thrombolysis for treatment of thrombosed dialysis access grafts.
abstract: The results of pulse-spray pharmacomechanical thrombolysis (PSPMT) of 209 thrombosed hemodialysis grafts were reviewed. In PSPMT, concentrated urokinase is injected forcefully through catheters with multiple tiny sideholes or sideslits. Catheters placed in a crisscross fashion cover the entire clot simultaneously. This therapy was successful in treating patients with thrombosed grafts. Of the 200 grafts with complete therapy, 197 grafts (99%) were patent at the end of the procedure. Mean time for pulsed-spray lysis was 40 minutes. Etiologies for graft thrombosis were anastomotic venous outflow stenosis, stenosis of the venous outflow away from the anastomosis, arterial stenosis, intragraft stenosis, pseudoaneurysms, and no identifiable cause in a small percentage. There were 16 complications, 8 of which required additional therapy or potentially compromised the graft. These results suggest that pharmacomechanical thrombolysis and angioplasty provide rapid, consistent, and safe recanalization of thrombosed hemodialysis grafts and represent an additional therapeutic approach to graft management.
authors.affiliation: Department of Radiology, University of California San Diego Medical Center.
authors.forename: A C
authors.initials: AC
authors.lastname: Roberts
authors.forename: K
authors.initials: K
authors.lastname: Valji
authors.forename: J J
authors.initials: JJ
authors.lastname: Bookstein
authors.forename: R J
authors.initials: RJ
authors.lastname: Hye
mesh_terms: D000800:Angioplasty, Balloon; D001807:Blood Vessel Prosthesis; D002404:Catheterization / Q000379:methods; D005466:Fluorocarbons; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005466:Fluorocarbons; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator; C015531:tetrafluoroethylene