Contemporary treatment of thrombosed hemodialysis grafts.
Maintaining hemodialysis grafts remains a difficult problem. Before the early 1990s, graft declotting was usually performed in the surgical suite. Percutaneous declotting has been evolving since the mid-1980s. Initially, a low-dose thrombolytic infusion of streptokinase through a single catheter was used. Crossing catheters with a higher-dose infusion of urokinase was then introduced. This technique was modified with the adjunctive use of pharmacomechanical techniques with the use of compliant balloons and the adjunctive use of heparin. The advent of the "lyse-and-wait" technique provided a simpler and quicker way to declot thrombosed grafts by using urokinase, with similar outcomes. Since the removal of urokinase from the market, multiple mechanical devices have been used with similar success. Recent reports concerning the use of newer-generation thrombolytic agents report similar outcomes, with a reduction in total cost.
Gibbens
D T
DT
Department of Cardiovascular and Interventional Radiology, Community Medical Center, 99 Highway 37 West, Toms River, NJ 08755, USA.
Triolo
J
J
Yu
T
T
Depalma
J
J
Iglasias
J
J
Castner
D
D
D004867:Equipment Design; D004869:Equipment Safety; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy; D006801:Humans; D006435:Renal Dialysis; D017131:Thrombectomy / Q000191:economics / Q000295:instrumentation / Q000592:standards; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications* / Q000628:therapy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D014654:Vascular Patency / Q000187:drug effects
D005343:Fibrinolytic Agents