Open AccessUSG-guided needle-directed pulse-spray pharmaco-mechanical thrombolysis of hemodialysis grafts/fistula: A novel technique
Author(s) -
Ks Amitha Vikrama,
N Srivalli,
Raju S Venkataramana
Publication year - 2015
Publication title -
indian journal of radiology and imaging - new series/indian journal of radiology and imaging/indian journal of radiology and imaging
Language(s) - English
Resource type - Journals
eISSN - 0971-3026
pISSN - 0970-2016
DOI - 10.4103/0971-3026.161442
Subject(s) - medicine , hemodialysis , thrombolysis , dialysis , catheter , dialysis catheter , hemodialysis access , surgery , fistula , arteriovenous fistula , intensive care medicine , vascular access , myocardial infarction
The incidence of end-stage renal disease is significantly increasing and most patients who require renal transplantation are undergoing hemodialysis through tunneled/non-tunneled dialysis catheters and arteriovenous fistulas. The greatest disadvantage of the hemodialysis access is the limited durability of the arteriovenous fistulas and grafts, which, on average, remain patent for <3 years, but are the lifeline for hemodialysis patients. Catheter-directed interventions are successful in re-establishing flow in more than 80% of thrombosed hemodialysis fistulas and have become the treatment of choice for failing or thrombosed accesses. However, these interventions are expensive and require a tertiary center with well-equipped labs. The novel technique of needle-directed thrombolysis is less expensive and can be done on an OPD basis in any primary healthcare setup. To the extent we have searched, no such technique has been published so far in the English literature.