IN-SITU FIBRINOLYSIS OF ACUTE THROMBOSIS OF THE ARTERIOVENOUS-FISTULAIN HEMODIALYSIS-PATIENTS

Several techniques (surgical revision, thrombectomy,...) have been des cribed for the treatment of thrombosed vascular access (VA) in hemodia lysis patients. We propose a technique with local thrombolytic infusio n in conjunction with angiography and percutaneous dilatation and/or r ecanalization. A total of fourteen patients with twenty-two episodes o f thrombosed VA was studied. Eleven patients had a Brescia-Cimino flst ula and three patients had a graft fistula. We used in 21 cases urokin ase (243000 Ul +/- 100000 Ul) and in 1 case rt-PA (50 mg). Of the 22 V A, 19 issued in an immediate patency and were restored to full functio n; and wherof 17 remained patent more than 2 weeks. Failures occured i n 3 cases: localized bleeding from previous dialysis puncture sites (1 ), venous outflow obstruction (1), and resistant venous stenosis (1). There were no infectious complications, and no systemic bleeding compl ications. We observed one pseudoaneurysm and one humeral asymptomatic thrombo-embolism. Stenoses were the most frequent factor in precipitat ing thrombosis. We believe that our technique should be the first line of treatment of occluded hemodialysis vascular access.