PULSE-SPRAY PHARMACOMECHANICAL THROMBOLYSIS FOR TREATMENT OF THROMBOSED DIALYSIS ACCESS GRAFTS

The results of pulse-spray pharmacomechanical thrombolysis (PSPMT) of 209 thrombosed hemodialysis grafts were reviewed. In PSPMT, concentrat ed urokinase is injected forcefully through catheters with multiple ti ny sideholes or sideslits. Catheters placed in a crisscross fashion co ver the entire clot simultaneously. This therapy was successful in tre ating patients with thrombosed grafts. Of the 200 grafts with complete therapy, 197 grafts (99%) were patent at the end of the procedure. Me an time for pulsed-spray lysis was 40 minutes. Etiologies for graft th rombosis were anastomotic venous outflow stenosis, stenosis of the ven ous outflow away from the anastomosis, arterial stenosis, intragraft s tenosis, pseudoaneurysms, and no identifiable cause in a small percent age. There were 16 complications, 8 of which required additional thera py or potentially compromised the graft. These results suggest that ph armacomechanical thrombolysis and angioplasty provide rapid, consisten t, and safe recanalization of thrombosed hemodialysis grafts and repre sent an additional therapeutic approach to graft management.