Reteplase in the treatment of thrombosed hemodialysis grafts.
OBJECTIVE
To prospectively evaluate the efficacy and safety of reteplase with percutaneous transluminal angioplasty (PTA) in the treatment of thrombosed polytetrafluoroethylene hemodialysis arteriovenous grafts (AVGs).


METHODS
Forty-two patients were entered into the study. Sixty-two procedures in 43 grafts were performed. One unit of reteplase and 4,000 units of heparin were administered into the AVGs. Routine venography and percutaneous transluminal angioplasty (PTA) was then performed. Patients were transferred for hemodialysis immediately after the procedure.


RESULTS
Technical success was achieved in 92% of the cases. Four cases involved intentional repeat thrombosis because of poor outflow and/or need for a new graft site. Minor complications occurred in 6.5% of the cases. No major complications occurred. The mean procedure time for experienced versus less-experienced interventionalists was significantly shorter (P <.001). Primary patency rates were 50%, 34%, and 34% at 30, 90, and 180 days, respectively.


CONCLUSIONS
Reteplase in conjunction with heparin and PTA is a safe and effective means of thrombolysis of AVGs. Its efficacy is comparable to that of other available thrombolytic drugs.
Falk
A
A
Department of Radiology, Mount Sinai-NYU Medical Center, One Gustave L. Levy Place, New York, New York 10029-6574, USA. abigail1falk123@pol.net
Guller
J
J
Nowakowski
F S
FS
Mitty
H
H
Teodorescu
V
V
Uribarri
J
J
Vassalotti
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon; D001807:Blood Vessel Prosthesis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006083:Graft Occlusion, Vascular / Q000188:drug therapy* / Q000628:therapy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use*; D006435:Renal Dialysis; D018709:Statistics, Nonparametric; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014654:Vascular Patency
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D011138:Polytetrafluoroethylene; D006493:Heparin; C087896:reteplase; D010959:Tissue Plasminogen Activator