Mechanical thrombolysis for the treatment of thrombosed hemodialysis access grafts.
OBJECTIVE
To evaluate the data acquired over 2 1/2 years regarding the use of mechanical thrombolysis as the routine, preferred treatment for thrombosed access grafts in a large patient population undergoing hemodialysis.


METHODS
Mechanical thrombolysis was performed in 1,176 cases. Data were collected on the success rate, complication rate, long-term patency, and presence and location of stenosis. The results of mechanical thrombolysis were compared with those of surgery. All data were collected prospectively.


RESULTS
Thrombosed grafts were treated successfully in 1,123 of 1,176 cases (95%). Minor complications occurred in 34 cases (3%). Venous stenosis was present in 1,054 cases (90%). Long-term patency rates were 74% at 30 days, 52% at 90 days, and 17% at 360 days. The thrombosis rate per patient per year and the number of patients who required graft revision or replacement decreased in comparison with the results obtained with surgical treatment.


CONCLUSIONS
Mechanical thrombolysis was effective, quick, and safe. Percutaneous treatment should be adopted as the treatment of choice for thrombosed hemodialysis access grafts.
Beathard
G A
GA
Austin Diagnostic Clinic, TX 78758, USA.
Welch
B R
BR
Maidment
H J
HJ
D000779:Anesthetics, Local; D000800:Angioplasty, Balloon / Q000295:instrumentation / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000706:statistics & numerical data; D001807:Blood Vessel Prosthesis; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D016009:Chi-Square Distribution; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008012:Lidocaine; D015993:Life Tables; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D006435:Renal Dialysis; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013927:Thrombosis / Q000628:therapy*
D000779:Anesthetics, Local; D011138:Polytetrafluoroethylene; D008012:Lidocaine