Percutaneous treatment of complications occurring during hemodialysis graft recanalization.
OBJECTIVE
To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts.


METHODS
A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma.


RESULTS
Twelve cases of post angioplasty ruptures were treated with uncovered stents of which 10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations were successfully treated by digital compression while the procedure was completed and the graft flow was restored. Dissections were treated with prolonged Percutaneous Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48 (81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62 and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained over 50% at 1 year. There were no additional complications caused by these maneuvers.


CONCLUSIONS
The majority of complications occurring during percutaneous thrombolysis/thrombectomy of thrombosed access grafts, can be treated at the same sitting allowing completion of the recanalization procedure and usage of the same access for hemodialysis.
Sofocleous
Constantinos T
CT
Department of Radiology Vascular and Interventional, University of Medicine and Dentistry of New Jersey, University Hospital, C320 150 Bergen Street, Newark, NJ 07103-2406, USA. constant@pol.net
Schur
Israel
I
Koh
Elsie
E
Hinrichs
Clay
C
Cooper
Stanley G
SG
Welber
Adam
A
Brountzos
Elias
E
Kelekis
Dimitris
D
D017130:Angioplasty / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000150:complications* / Q000628:therapy*; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D015607:Stents; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000150:complications / Q000628:therapy