THROMBOLYSIS OF OCCLUDED CENTRAL VENOUS C ATHETERS WITH LOW-DOSE UROKINASE IN HEMODIALYSIS-PATIENTS

Thrombosis of the double-lumen central venous dialysis-catheter freque ntly disables it's continuous use. We, therefore, have studied the eff iciency of thrombolysis with urokinase to restore catheter function in haemodialysis patients. During 13 months, 28 episodes of catheter thr ombosis were observed in 8 males and 7 females (mean age: 69,3 +/- 12, 6 years) who had a Permcath (Quinton, USA) as vascular access. A mean of 2,1 +/- 1,1 cykles of low-dose urokinase (1,000 IU/ml, 1,5 ml/lumen , 10 min.) were effective to reopen the catheter in 75% of cases. In f irst thrombosis the rate of successful thrombolysis amounted to 93% be ing significantly superior to subsequent thromboses. No side-effects w ere observed. After successful thrombolysis dialysis was possible in 6 7% of cases. Lysis failed or dialyses were impossible due to mechanica l obstruction of the catheter (ligated by suture), fibrin sheat around the catheter with thrombus at the tip acting in a bail-valve manner, or malposition of the catheter. Our results show, that low-dose urokin ase is effective to restore catheter function in 2/3 of thrombotic epi sodes without any side-effects. A surgical intervention can be avoided in these patients. Moreover, thrombolysis of clotted catheters with u rokinase is markedly preferable in terms of economics compared to surg ical revision.