Synthetic dialysis shunts: thrombolysis with the Cragg thrombolytic brush catheter.
OBJECTIVE
To evaluate the effectiveness of the Cragg thrombolytic brush catheter for declotting of synthetic arteriovenous dialysis shunts.


METHODS
In this randomized controlled trial, 77 patients with synthetic forearm loop shunts that were thrombosed were randomly assigned to undergo pharmacomechanical thrombolysis with a pulsed spray (n = 34) or a thrombolytic brush catheter (n = 43). The following findings were evaluated: declotting time, urokinase dose, procedure time, complications, and shunt patency at the first dialysis session and at 3 months. All data were collected prospectively in an unblinded manner.


RESULTS
The total amount of urokinase used, including secondary interventions, was 243,657 IU with the catheter versus 476,563 IU with the pulsed spray (P = .001). At 15 minutes, clot lysis was successful in 66% of the patients with the catheter versus in 19% with the pulsed spray (P = .001). At 30 minutes, clot lysis was successful in 98% with the catheter versus 47% with the pulsed spray (P = .001). Procedure complication rates and patency at 3 months were similar for the catheter and the pulsed-spray groups.


CONCLUSIONS
Use of the Cragg catheter with urokinase offered faster and more complete clot lysis than did use of the pulsed spray with urokinase. The amount of urokinase used with the catheter was half that used with the pulsed spray. Shunt patency at 3 months was similar for the two treatment methods.
Dolmatch
B L
BL
Department of Radiology, Cleveland Clinic Foundation, OH 44195, USA.
Casteneda
F
F
McNamara
T O
TO
Zemel
G
G
Lieber
M
M
Cragg
A H
AH
D001166:Arteriovenous Shunt, Surgical; D002404:Catheterization / Q000295:instrumentation*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators; D011446:Prospective Studies; D006435:Renal Dialysis; D015912:Thrombolytic Therapy / Q000295:instrumentation* / Q000379:methods; D013927:Thrombosis / Q000188:drug therapy*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage
D006493:Heparin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator