THROMBOLYSIS VERSUS SURGERY FOR THE TREATMENT OF THROMBOSED DIALYSIS ACCESS GRAFTS

Thrombolysis offers several advantages over surgery in the treatment o f thrombosed dialysis access grafts, This study was undertaken to comp are the results obtained when thrombolysis was used as the preferred t reatment (Thrombolysis Period) for this problem in comparison with the results that had been obtained when surgical therapy had been the pre ferred treatment (Surgery Period), Each period of study lasted 12 mont hs and the two periods ran consecutively, All data were collected pros pectively. No significant problems were encountered when thrombolysis was substituted for surgical therapy as the preferred treatment of thr ombosed dialysis access grafts, During the Surgical Period there were 580 thrombotic episodes, a rate of 0.86 per patient, During the Thromb olysis Period there were 568 episodes, a rate of 0.76, These differenc es were not statistically significant, During the Thrombolysis Period, thrombolysis was found to be as effective as surgery had been during the Surgical Period in the initial treatment of thrombosed grafts, The rate of surgical revision was decreased by two-thirds during the Thro mbolysis Period, but the rate of graft replacement was not altered, Lo ng-term patency after therapy by thrombolysis during the Thrombolysis Period was superior to that for surgical thrombectomy performed during the Surgical Period, and was equal to that for revision and graft rep lacement, The complication rate for thrombolysis was low and complicat ions were managed easily without sequelae, It is concluded that thromb olysis is safe and, when used as the preferred treatment for thrombose d dialysis access grafts, is as effective as surgical therapy, Since i t preserves potential vascular access sites and yields long-term paten cy rates superior to those for surgical thrombectomy, it should be reg arded as the treatment of choice for this problem.