THROMBOSED HEMODIALYSIS GRAFTS - PERCUTANEOUS MECHANICAL BALLOON DECLOTTING VERSUS THROMBOLYSIS

PURPOSE: To compare a technique of mechanical balloon declotting of th rombosed hemodialysis grafts with conventional pulsed-spray thrombolys is. MATERIALS AND METHODS: Forty patients had 53 episodes of graft thr ombosis over a 19-month period. Twenty-nine grafts were randomly treat ed with thrombolysis with urokinase and 24 grafts with mechanical decl otting by placement of crossed balloon catheters within the graft Pate ncy was determined by retrospective review of hemodialysis records. RE SULTS: Successful hemodialysis for 1 week after the procedure was achi eved in 21 (88%) of the 24 grafts treated mechanically and 26 (90%) of 29 grafts treated with thrombolysis. Continuous pulse oximetry showed no change in oxygen saturation in either group, and no clinical signs or symptoms of pulmonary embolism were noted. Average total procedure times were 2.2 hours for mechanical declotting and 3.5 hours for thro mbolysis (P < .05). Probability of patency (mechanical vs thrombolysis ) was 42% vs 45% at 3 months, 36% vs 25% at 6 months, and 8% vs 4% at 12 months. One major complication of ulnar artery embolization occurre d in the thrombolysis group. CONCLUSION: Mechanical declotting of hemo dialysis grafts is faster and as effective as thrombolysis.