Percutaneous treatment of failed native dialysis fistulas: use of pulse-spray pharmacomechanical thrombolysis as the primary mode of therapy.
OBJECTIVE
To determine the efficacy and outcome of percutaneous treatment in restoring the function of failed native arteriovenous fistulas (AVFs) where pulse-spray pharmacomechanical thrombolysis was used as the primary mode of therapy.


METHODS
From June 2001 to July 2005, 14 patients who had thrombosis of native AVFs underwent percutaneous restoration following 20 episodes of thrombosis. These included 6 repeated episodes in one forearm AVF and two episodes in another forearm AVF. All patients except one were treated with urokinase injection utilizing the pulse-spray technique and had subsequent balloon angioplasty. One patient was treated by percutaneous angioplasty alone. We retrospectively evaluated the feasibility of percutaneous treatment in restoring the function of the failed AVFs. The primary and secondary patencies were calculated by using a Kaplan-Meier analysis.


RESULTS
Both technical and clinical success were achieved in 15 (75%) of 20 AVFs. Four of the five technical failures resulted from a failure to cross the occluded segment. One patient refused further participation in the trial through a brachial artery access following failure to cross the occluded segment via an initial retrograde venous puncture. There were no major procedure related complications observed. Including the initial technical failures, primary patency rates at six and 12 months were 64% and 55%, respectively. Secondary patency rates at six and 12 months were 71% and 63%, respectively.


CONCLUSIONS
Pulse-spray pharmacomechanical thrombolysis for treatment of the thrombosed AVFs is safe, effective and durable. This procedure should be considered as an option for the management of failed AVFs prior to surgical intervention.
Cho
Sung Ki
SK
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Han
Heon
H
Kim
Sam Soo
SS
Lee
Ji Yeon
JY
Shin
Sung Wook
SW
Do
Young Soo
YS
Park
Kwang Bo
KB
Choo
Sung Wook
SW
Choo
In-Wook
IW
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D006435:Renal Dialysis / Q000009:adverse effects*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*; D017211:Treatment Failure; D016896:Treatment Outcome
D005343:Fibrinolytic Agents