PERCUTANEOUS TREATMENT POSSIBILITIES IN T HROMBOTIC OCCLUSION OF BRESCIA-CIMINO DIALYSIS SHUNTS

Purpose: Acute thrombotic occlusion of Brescia-Cimino forearm fistulae is a severe complication. Aspects of percutaneous therapy include bal loon dilatation, thrombolysis and mechanical thrombectomy. We report o n 21 cases with obstructed shunts. Clinical evaluation and palpation h elped to select each shunt for an individual therapeutic approach. Pat ients and methods: One patient presented with a proximal arterial occl usion, three patients with a small occluding thrombus, 4 patients with a severe stenosis but only a small amount of thrombus and 13 patients with an extended amount of clot material. Results: 7 patients underwe nt balloon dilatation alone, three patients thrombolysis with rtPA and 11 patients hydrodynamic thrombectomy. Arterialised shunt flow was re established in 20 of 21 cases. The shunt was reused for dialysis in 17 cases. Reobstruction within two weeks after intervention occurred in two cases. Conclusions: With regard to the individual clot size, diffe rent percutaneous methods are available for successful shunt recanalis ation.