PURPOSE: To prospectively evaluate the efficacy of a low-dose, 3-hour recom
binant tissue plasminogen activator (rt-PA) infusion for the treatment of h
emodialysis catheter (HDC)-associated fibrin sheaths.
MATERIALS AND METHODS: Seventeen patients with end-stage renal disease (fem
ale, n = 11; male, n = 6), who were undergoing catheter-directed hemodialys
is, were evaluated for 28 episodes of HDC dysfunction. This patient group r
anged in age from 25 to 92 years (mean, 57 years). Radiographic contrast an
d/or clinical evaluation were consistent with the presence of a fibrin shea
th on either the arterial and/or venous port in all cases. Patients subsequ
ently underwent a thrombolytic infusion consisting of 2.5 mg rt-PA in 50 mL
normal saline at a rate of 17 mL/h (3-hour infusion) per port. All infusio
ns were performed in the interventional radiology recovery room, on an outp
atient basis. Patients were followed-up prospectively for technical success
, complications, catheter patency, and long-term outcome.
RESULTS: The immediate technical success rate, defined as return. of manual
aspiration and infusion capabilities to both ports, was 100%. No potential
patients required exclusion from thrombolytic therapy secondary to contrai
ndications, and no procedure-related complications occurred. The arithmetic
mean and median catheter patency at the end of the study was 41 and 25 day
s, respectively (range, 1-116 days). A Kaplan-Meier survival analysis yield
ed a 30-, 60-, and 90-day probability of patency of 0.67, 0.61, and 0.51, r
espectively. At the end of the study period, all 17 patients remained on ca
theter-directed hemodialysis and 13 (76%) were utilizing the same catheter
present at the time of entrance into the study.
CONCLUSION: Thrombolytic therapy utilizing a 2.5-mg rt-PA infusion through
each port during a 3-hour period would appear to be a safe, efficient metho
d for treating HDC-associated fibrin sheaths. Three-month patency rates are
comparable to those reported for other methods of restoring function to HD
C catheters, including new catheter placement, catheter exchange over a gui
de wire, thrombolytic infusions with urokinase, and percutaneous fibrin she
ath stripping.