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Thrombectomy of Prosthetic Dialysis Grafts Using Mechanical Plus “No‐Wait Lysis” Approach Requires Less Procedure Time and Radiation Exposure
Author(s) -
Almehmi Ammar,
Broce Mike,
Wang Shouwen
Publication year - 2011
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2011.00922.x
Subject(s) - medicine , lysis , dialysis , surgery , thrombolysis , angioplasty , radiation exposure , urology , nuclear medicine , immunology , myocardial infarction
In spite of the existence of various strategies, dialysis graft thrombectomy remains time‐consuming and requires substantial radiation exposure. The authors report a new approach for graft thrombectomy, “no‐wait lysis”, with the objective to examine its effect on procedure time and radiation exposure. Based on the use of tissue plasminogen activator (tPA), the 88 retrospectively reviewed graft thrombectomies were divided into “no‐tPA” group ( n = 35) and “no‐wait lysis” group ( n = 53). Fogarty thrombectomy and balloon angioplasty were used similarly in both groups. In the “no‐wait lysis” group, small‐dose tPA was added directly into the graft during the procedure. Comparing the “no‐wait lysis” group with the “no‐tPA” group, the procedure time was reduced: 27.2 ± 10.2 vs. 55.5 ± 19.9 minutes ( p < 0.0001), and the radiation exposure time was decreased correspondingly: 159.4 ± 61.6 vs. 243.9 ± 101.9 seconds ( p < 0.0001). Multivariate regression analysis revealed that the use of “no‐wait lysis” approach was the major significant predictor for shorter procedure time and radiation exposure time. In conclusion, our data support that the use of “no‐wait lysis” approach for dialysis graft thrombectomy substantially reduces procedure time and radiation exposure, and it may serve as an efficient and economical alternative to other existing approaches.