Comparative efficacy of pulse-spray thrombolysis and angioplasty versus surgical salvage procedures for treatment of recurrent occlusion of PTFE dialysis access grafts.
OBJECTIVE
To compare the efficacy of surgery versus pulse-spray thrombolysis and angioplasty in patients with recurrent thrombosis of polytetrafluoroethylene (PTFE) dialysis access grafts.


METHODS
We analyzed 96 consecutive interventions for thrombosed PTFE dialysis access grafts in 18 patients. Primary patency after thrombolysis and angioplasty (n = 25) was compared with primary patency following thrombectomy alone (n = 50) or thrombectomy followed by graft revision (n = 21) using life-table analysis. A Cox proportional hazards model that accounted for graft age and number of previous interventions was used to generate the relative risk for recurrent occlusion following therapy.


RESULTS
Life-table analysis showed that patency after thrombolysis and angioplasty was greater than that following thrombectomy alone (p = 0.02). After accounting for the age of the graft and the number of previous interventions (average six per patient), the relative risk for recurrent occlusion [3.0; 95% confidence intervals (CI): 1.5, 6.4] was greater for thrombectomy alone than for thrombolysis/angioplasty [0.6; CI = 0.3, 1.3]. The relative risks of repeat occlusion following thrombolysis/angioplasty [0.6; CI = 0.3, 1.3] and thrombectomy/surgical revision [1.0; CI = 0.5, 1.7] were similar.


CONCLUSIONS
Outcome data from our retrospective study on recurrent thrombosis of PTFE dialysis access grafts suggest that thrombolysis/angioplasty is superior to thrombectomy alone, and equivalent to thrombectomy/surgical revision.
Polak
J F
JF
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Berger
M F
MF
Pagan-Marin
H
H
Aruny
J E
JE
Meyerovitz
M F
MF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D002408:Catheters, Indwelling / Q000009:adverse effects; D016001:Confidence Intervals; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D016016:Proportional Hazards Models; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D014654:Vascular Patency
D011138:Polytetrafluoroethylene