Treating thrombotic prosthetic arteriovenous access with cross-balloon occlusive thrombolysis and angioplasty.
OBJECTIVE
Clot embolism remains a concern due to flushing of clot and thrombolytic agent centrally in the process of percutaneous pharmacomechanical thrombolysis (PMT) for a thrombosed prosthetic arteriovenous access (PAVA), which might be reduced by a modified technique.


METHODS
We retrospectively review this modified technique that uses two balloon-catheters in crisscross fashion and occludes both ends of PAVA during thrombolysis. Underlying stenotic lesions were dilated simultaneously with balloon angioplasty when needed.


RESULTS
Among the 23 patients treated, 21 (91.3%), 10 (43.5%), and seven (30.4%) presented significant stenosis at the outflow, intragraft, and inflow segments of PAVA, respectively. The median duration of follow-up was 310.0 (range, 288.0-327.0) days. Anatomic success was achieved in 12 out of 23 (52.2%). Clinical success for successful dialysis was achieved in all patients. The median primary patency and secondary patency were 126.0 days (range, 7.0-316.0) days and 308.0 days (range, 84.0-327.0), respectively.


CONCLUSIONS
We believe this method is safe and effective in dissolving PAVA thrombus as well as treating culprit stenosis. It may reduce concerns of flushing of clot and thrombolytic agent into the central circulation in the process of PMT.
Division of Cardiovascular Surgery, Taipei Mackay Memorial Hospital, Taiwan.
Shen
S
Sun
Heng-Wen
HW
Chou
Jer-Shen
JS
Chen
Chih-Yang
CY
Chan
D000368:Aged; D000369:Aged, 80 and over; D000800:Angioplasty, Balloon / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D013927:Thrombosis / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome