Open AccessThrombosed dialysis grafts: efficacy of intrathrombic deposition of concentrated urokinase, clot maceration, and angioplasty
Author(s) -
Davis Gb,
Dowd Cf,
J J Bookstein,
Maroney Tp,
Lang Ev,
Nicholas A. Halasz
Publication year - 1987
Publication title -
american journal of roentgenology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.294
H-Index - 196
eISSN - 1546-3141
pISSN - 0361-803X
DOI - 10.2214/ajr.149.1.177
Subject(s) - medicine , urokinase , thrombolysis , stenosis , angioplasty , hemodialysis , surgery , dialysis , catheter , percutaneous , tenecteplase , hemodialysis catheter , radiology , cardiology , myocardial infarction
Forty-one thrombosed polytetrafluoroethylene hemodialysis grafts in 26 patients were treated by a modified method of fibrinolytic therapy and transluminal angioplasty. The modifications included the use of highly concentrated urokinase, intrathrombic injection of urokinase into mechanically macerated thrombi, use of a crossed two-catheter technique, observation of the patient in the angiography suite during the entire procedure, and transluminal angioplasty to correct underlying stenosis immediately after partial or complete thrombolysis. Lysis was initially successful in 37 (90%) of 41 procedures. Successful treatment, defined as a functional graft for longer than 6 months without intervening surgery, was achieved in 16 (62%) of 26 patients. In comparison with previous transluminal or surgical regimens, this modified method permits marked acceleration of thrombolysis, immediate transluminal angioplasty, and sparing of potential future graft sites.