Microbubble potentiated ultrasound as a method of declotting thrombosed dialysis grafts: experimental study in dogs.
Intravenous perfluorocarbon-exposed sonicated dextrose albumin (PESDA) microbubbles in the presence of low frequency ultrasound (LFUS) can lyse very small clots. We develop a similar method to declot full-size arteriovenous dialysis grafts. Dialysis grafts fashioned in three dogs were cannulated and ligated. After thrombosis, three declotting techniques were randomly applied: 1) direct injection of PESDA + LFUS; 2) direct injection of saline + LFUS; and 3) intravenous PESDA + LFUS. Declotting was graded by cine angiography scores of each third of the graft on a scale of 0-4 (maximum total score = 12). Twenty-six procedures showed mean patency scores of 11.1 for direct PESDA and 8.4 for i.v. PESDA, vs 4.9 for direct saline, p = <0.001. All eight direct PESDA injections achieved lysis and good flow, but none of 8 direct saline injections succeeded, p = <0.01. Intravenous PESDA succeeded in 4 of 10 procedures, p = <0.04 vs saline. Direct injection of PESDA with transcutaneous LFUS succeeds in lysing moderate-size clots and recanalizing thrombosed fistulas.
Culp
W C
WC
University of Nebraska Medical Center, Omaha 68198-1045, USA.
Porter
T R
TR
Xie
F
F
Goertzen
T C
TC
McCowan
T C
TC
Vonk
B N
BN
Baxter
B T
BT
D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects; D003287:Contrast Media / Q000627:therapeutic use; D003956:Dialysis / Q000009:adverse effects*; D004195:Disease Models, Animal; D004285:Dogs; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000473:pathology; D005466:Fluorocarbons / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D007275:Injections, Intravenous; D007866:Leg / Q000098:blood supply / Q000000981:diagnostic imaging; D012709:Serum Albumin / Q000627:therapeutic use; D000075462:Serum Albumin, Human; D013927:Thrombosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000209:etiology*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D014654:Vascular Patency / Q000187:drug effects
D003287:Contrast Media; D005466:Fluorocarbons; D012709:Serum Albumin; C094311:dextrose albumin solution; D005947:Glucose; D000075462:Serum Albumin, Human