Alteplase for hemodialysis access graft thrombolysis.
OBJECTIVE
To evaluate the efficacy and safety of alteplase, a recombinant tissue plasminogen activator, in hemodialysis access graft thrombolysis.


METHODS
From November 1999 to May 2001, 68 episodes of occlusion in 50 grafts (in 49 patients) were included in the study. Occlusion was treated with pulse-spray (n = 41) or lyse-and-wait (n = 27) thrombolysis with use of alteplase. Balloon angioplasty of all identified stenoses was performed. The arterial plug was mobilized with the Fogarty maneuver.


RESULTS
Procedural success was achieved in 64 of 68 episodes (94%) with a dose of 2-10 mg (mean = 4.13 mg) of alteplase, allowing successful hemodialysis within 24 hours. Failures (6%) were the result of PTA perforation (one of 68), nonnegotiable outflow occlusion (one of 68), delayed bleeding (one of 68), and balloon bursting and shearing becoming occlusive within the graft (one of 68). Primary and secondary patency rates were 72% and 87% at 30 days, 57% and 80% at 90 days, and 44% and 72% at 180 days, respectively. Arterial emboli (two of 68) were treated by Fogarty balloon retrieval and alteplase infusion locally over the course of 20 minutes. One of two PTA perforations was controlled by balloon tamponade.


CONCLUSIONS
Alteplase can be used successfully for hemodialysis graft thrombolysis.
Sofocleous
Constantinos T
CT
Department of Radiology, UMDNJ-New Jersey Medical School, Newark, New Jersey 07103, USA. constant@pol.net
Hinrichs
Clay R
CR
Weiss
Stanley H
SH
Contractor
Daniel
D
Barone
Allison
A
Bahramipour
Philip
P
Brountzos
Elias
E
Kelekis
Dimitris
D
D000328:Adult; D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015607:Stents; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator