Pharmacomechanical thrombolysis and angioplasty in the management of clotted hemodialysis grafts: early and late clinical results.

Valji, Karim; Bookstein, Joseph J.; Roberts, Anne C.; Davis, Gary B.

doi:10.1148/radiology.178.1.1824582

Cited by 179 publications

(81 citation statements)

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“…[8 -19] These methods include pulse-spray thrombolysis with urokinase supplementation and balloon maceration of residual clot, [8,9] crossed catheter pharmacomechanical thrombolysis, [10] and mechanical thrombectomy using thrombectomy catheter and clot aspiration. [14,15] These methods have reported technical success rates of 75% 92%, but experiences were limited to PTFE grafts.…”

Section: Discussionmentioning

confidence: 99%

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

et al. 2005

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Background. To investigate the safety, feasibility, efficacy, and long-term patency rate of manual declotting under duplex ultrasound (US) guidance followed by percutaneous transluminal angioplasty (PTA) in thrombosed native arteriovenous fistulas (AVFs). Methods. Of 87 consecutive thrombosed AVFs evaluated by duplex US, 22 patients with 25 recently thrombotic events in 22 AVFs were suitable for manual declotting. PTA was performed following successful declotting, and long-term patency was assessed. Results. The procedure success rate of manual declotting was 80% (20 of 25), and a residual stenosis of 74 ± 9% was identified by duplex US after declotting. PTA reduced the diameter stenosis to 25 ± 6% and increased the lumen diameter from 1.33 ± 0.85 mm to 4.62 ± 0.98 mm. Neither embolic nor bleeding complications were noted during the procedure. The average procedure time and the fluoroscopy time were 28.4 ± 9.9 and 7.2 ± 4.1 minutes, respectively. Primary patency rates at 1, 2, and 3 years were 47%, 35%, and 28%; assisted primary patency rates at 1, 2, and 3 years were 71%, 63%, and 63%; and secondary patency rates at 1, 2, and 3 years were 76%, 71%, and 63%, respectively, during a maximum follow-up period of 42 months. Conclusion. The combination of duplex US-guided manual declotting and angioplasty of underlying stenosis is a safe and feasible method to treat recently thrombosed native AVFs in selected patients. It simplifies the interventional procedure, reduces cost and radiation exposure time, and extends life span of dialysis fistula with acceptable long-term patency rate.

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Section: Discussionmentioning

confidence: 99%

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

et al. 2005

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“…Access patency is limited by the development of fistula stenosis either at the venous anastomotic site or in the downstream vein. These stenoses cause more than 80% of AV access thromboses [5,6], which themselves account for 80-85% of AV access failures.…”

Section: Introductionmentioning

confidence: 99%

Is AV Fistula Patency Associated with Angiotensin-Converting Enzyme (ACE) Polymorphism and ACE Inhibitor Intake?

Heine¹,

Ulrich²,

Köhler³

et al. 2004

Am J Nephrol

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Background/Aims: Hemodialysis treatment requires a well-functioning vascular access. Access patency is limited by the development of venous intimal hyperplasia, which predisposes to fistula stenosis and subsequent thrombosis. In animal models, the renin-angiotensin system has a major role in the development of intimal hyperplasia. We investigated the association of the insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE) and arteriovenous fistula patency in hemodialysis patients. Methods: In a longitudinal study, 137 hemodialysis patients who had undergone creation of a primary AV fistula were genotyped. The main study endpoint was unassisted access patency (time from fistula placement to the first episode of access failure). In addition, the intake of drugs blocking the renin-angiotensin system was assessed. Results: Fistula patency 12 months after fistula creation was 72% (DD patients), 65% (ID patients), and 73% (II patients; p = 0.40). Long-term intake of ACE inhibitors or AT-1 antagonists failed to increase fistula patency (p = 0.33). Conclusions: We suggest that pharmacological inhibition of the renin-angiotensin system is of limited value for prevention of arteriovenous fistula stenosis. Alternative strategies to prolong fistula patency should be studied.

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“…Long-term results for dialysis grafts demonstrate primary and secondary patency rates at 1 year of 26% and 51%, respectively. 34 These results compare with 60-70% patency rates reported for surgical revision at 1 year. 35 With patients maintained on hemodialysis for longer periods of time, thrombolytic therapy can help preserve access sites.…”

Section: Venous Thrombolysismentioning

confidence: 65%

“…32 Several studies have demonstrated the efficacy of thrombolytic therapy in preserving long-term patency and viability of the access grafts. [32][33][34] In addition, thrombolytic therapy has allowed for improved evaluation of underlying venous limb stenosis predisposing to stasis and thrombosis. Long-term results for dialysis grafts demonstrate primary and secondary patency rates at 1 year of 26% and 51%, respectively.…”

Section: Venous Thrombolysismentioning

confidence: 99%

Percutaneous venous interventions

1998

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Percutaneous procedures by interventional radiologists are becoming an increasingly frequent part of the overall care of patients with complex venous thrombotic diseases. Inferior vena caval filters are used in the setting of failed or contraindicated anticoagulation. Catheterdirected thrombolysis is considered for patients with extensive iliofemoral deep venous thrombosis. Venous angioplasty is often indicated for patients with dialysis shunt venous stenoses, upper extremity venous stenoses and for stenoses within venous bypass grafts. Venous stenting is often employed following angioplasty to ensure long-term procedural success. Finally, suction and mechanical thrombectomy and embolectomy are relatively new procedures that are available to optimize patient management.

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Pharmacomechanical thrombolysis and angioplasty in the management of clotted hemodialysis grafts: early and late clinical results.

Cited by 179 publications

References 0 publications

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

Combination of Duplex Ultrasound-Guided Manual Declotting and Percutaneous Transluminal Angioplasty in Thrombosed Native Dialysis Fistulas

Is AV Fistula Patency Associated with Angiotensin-Converting Enzyme (ACE) Polymorphism and ACE Inhibitor Intake?

Percutaneous venous interventions

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