PULMONARY EMBOLI FROM PULSE-SPRAY AND MECHANICAL THROMBOLYSIS - EVALUATION WITH AN ANIMAL DIALYSIS-GRAFT MODEL

PURPOSE: To compare pulmonary emboli resulting from pulse-spray pharma comechanical thrombolysis (PSPMT) and mechanical thrombolysis performe d to declot dialysis-access grafts. MATERIALS AND METHODS: Polytetrafl uoroethylene arteriovenous shunts were created in eight dogs and were deliberately clotted at monthly intervals. Animals were randomly assig ned to treatment with pulse-spray urokinase thrombolysis or a low-spee d rotational percutaneous thrombolytic device. Perfusion imaging, pulm onary-artery pressure measurements, and pulmonary arteriography were p erformed before and after each procedure. RESULTS: A total of 22 proce dures were performed (11 PSPMT and 11 mechanical thrombolysis). Declot ting was successful in all procedures, with 100% 30-day patency. Segme ntal defects were seen on perfusion images after 10 (91%) of 11 PSPMT procedures and two (18%) of 11 mechanical thrombolysis procedures (P < .002). Transient increases in pulmonary-artery pressure occurred in th e PSPMT group. Complete resolution of emboli and return to baseline pr essures were seen in all cases, even after multiple (up to four) proce dures in the same animal. There was no histologic evidence of pulmonar y infarction in either group. CONCLUSION: The percutaneous thrombolyti c device is effective for declotting dialysis grafts in dogs and resul ts in statistically significantly fewer pulmonary emboli compared with PSPMT.