title: Time-extended local rtPA infiltration for acutely thrombosed hemodialysis fistulas.
abstract: This study describes results of a modified local thrombolysis technique for acutely thrombosed hemodialysis (HD) arteriovenous fistulas (AVF), which is characterized by prolonged recombinant tissue plasminogen activator (rtPA) local exposure times. Contrary to the standard lyse- and- wait (L&W) technique with local reaction times of 20-40 minutes, the modified protocol allows timing of challenging angioplasty maneuvers to the next regular working day.
  
  
  
  From February 2009 to April 2014, 84 patients on HD presented with 152 acutely thrombosed AVF. They proceeded to local thrombolysis including a single shot infiltration of rtPA, local reaction time up to 40 hours and finally percutaneous stenosis angioplasty. Success rates, major adverse events and need for temporary catheter placements (TCP) were retrospectively analyzed.
  
  
  
  The local thrombolysis time after single shot infiltration was 18.6 ± 6.2 (range 2-40) hours. Mean rtPA- dosage was 2.7 mg ± 1.2. The overall success rate was 89.5% and the major complication rate was 3.3%, whereas TCP was necessary in 12.5%. The PP/SP at 1, 3, 6, 12, 18, and 24 month were 86% ± 3%/95% ± 2%, 68% ± 4%/92% ± 2%, 43% ± 4%/90% ± 2%, 28% ± 4%/82% ± 3%, 12% ± 3%/82% ± 3%, 7% ± 2%/63% ± 4%, respectively.
  
  
  
  The modified L&W technique with prolonged local rtPA reaction times is a safe and effective declotting procedure. The need for TCP was not increased and therefore comparable to the standard technique.
authors.affiliation: Department of Vascular Surgery, University Hospital, Erlangen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Regus
authors.affiliation: Department of Vascular Surgery, University Hospital, Erlangen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Lang
authors.affiliation: Institute of Radiology, University Hospital, Erlangen, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Heinz
authors.affiliation: Department of Vascular Surgery, University Hospital, Erlangen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rother
authors.affiliation: Department of Vascular Surgery, University Hospital, Erlangen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Meyer
authors.affiliation: Department of Vascular Surgery, University Hospital, Erlangen, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Almási-Sperling
authors.affiliation: Institute of Radiology, University Hospital, Erlangen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Uder
authors.affiliation: Institute of Radiology, University Hospital, Erlangen, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Schmid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Lyse and wait technique; arteriovenous fistula; declotting procedures; hemodialysis; recombinant tissue plasminogen activator