Reteplase in the treatment of thrombosed hemodialysis grafts

PURPOSE: To prospectively evaluate the efficacy and safety of reteplase wit h percutaneous transluminal angioplasty (PTA) in the treatment of thrombose d polytetrafluoroethylene hemodialysis arteriovenous grafts (AVGs). MATERIALS AND METHODS: Forty-two patients were entered into the study. Sixt y-two procedures in 43 grafts were performed. One unit of reteplase and 4,0 00 units of heparin were administered into the AVGs. Routine venography and percutaneous transluminal angioplasty (PTA) was then performed. Patients w ere transferred for hemodialysis immediately after the procedure. RESULTS: Technical success was achieved in 92% of the cases. Four cases inv olved intentional repeat thrombosis because of poor outflow and/or need for a new graft site. Minor complications occurred in 6.5% of the cases. No ma jor complications occurred. The mean procedure time for experienced versus less-experienced interventionalists was significantly shorter (p < .001). P rimary patency rates were 50%, 34%, and 34% at 30, 90, and 180 days, respec tively. CONCLUSION: Reteplase in conjunction with heparin and PTA is a safe and eff ective means of thrombolysis of AVGs. Its efficacy is comparable to that of other available thrombolytic drugs.