Sp. Murray et al., Early rethrombosis of clotted hemodialysis grafts: Graft salvage achieved with an aggressive approach, AM J ROENTG, 175(2), 2000, pp. 529-532
Citations number
14
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging","Medical Research Diagnosis & Treatment
OBJECTIVE. The purpose of this study was to assess the efficacy of repeated
pulsed-spray pharmacomechanical thrombolysis for salvage of early rethromb
osis of hemodialysis grafts and to identify factors that predict successful
outcome.
MATERIALS AND METHODS. Thirty-four patients with initial successful thrombo
lysis were referred for repeated thrombolysis because of early rethrombosis
. Repeated thrombolysis occurred within 1 month of initial thrombolysis. Te
chnical success and patency rates were calculated. Causes of graft thrombos
is and procedural modifications were analyzed.
RESULTS. The 39 rethrombosed grafts were successfully treated using pharmac
omechanical thrombolysis, and patients underwent subsequent hemodialysis. T
he underlying flow-limiting stenoses were treated with balloon angioplasty
using a larger balloon (41%), a same-size angioplasty balloon (18%), stent
placement (15%), or increased anticoagulation (5%). A new stenosis location
was discovered in 18%. Mean primary patency was 80.9 days (2.6 months) and
secondary patency was 235.4 days (7.8 months). With life table analysis, 1
-, 3-, 6-, and 12-month primary patency rates were 72%, 31%, 23%, and 15%,
and secondary patency rates were 77%, 62%, 51%, and 31%, respectively. Graf
t patency rates in our study were compared with our institutional historic
graft patency rates, with no significant difference noted (p = 0.76). No ma
jor procedural complications occurred.
CONCLUSION. Adequate technical success and patency rates for pharmacomechan
ical thrombolysis occur even for hemodialysis grafts that rethrombose withi
n 1 month. After thrombolysis, aggressive search for and treatment of addit
ional stenoses are warranted.