Korean J Radiol.  2006 Sep;7(3):180-186. 10.3348/kjr.2006.7.3.180.

Percutaneous Treatment of Failed Native Dialysis Fistulas: Use of Pulse-Spray Pharmacomechanical Thrombolysis as the Primary Mode of Therapy

• Cho SK
• Han H
• Kim SS
• Lee JY
• Shin SW
• Do YS
• Park KB
• Choo SW
• Choo IW

• KMID: 1114350
• DOI: http://doi.org/10.3348/kjr.2006.7.3.180

Abstract

OBJECTIVE
To determine the efficacy and outcome of percutaneous treatment in restoring the function of failed native arteriovenous fistulas (AVFs) where pulse-spray pharmacomechanical thrombolysis was used as the primary mode of therapy. MATERIALS AND METHODS: From June 2001 to July 2005, 14 patients who had thrombosis of native AVFs underwent percutaneous restoration following 20 episodes of thrombosis. These included 6 repeated episodes in one forearm AVF and two episodes in another forearm AVF. All patients except one were treated with urokinase injection utilizing the pulse-spray technique and had subsequent balloon angioplasty. One patient was treated by percutaneous angioplasty alone. We retrospectively evaluated the feasibility of percutaneous treatment in restoring the function of the failed AVFs. The primary and secondary patencies were calculated by using a Kaplan-Meier analysis. RESULTS: Both technical and clinical success were achieved in 15 (75%) of 20 AVFs. Four of the five technical failures resulted from a failure to cross the occluded segment. One patient refused further participation in the trial through a brachial artery access following failure to cross the occluded segment via an initial retrograde venous puncture. There were no major precedure related complications observed. Including the initial technical failures, primary patency rates at six and 12 months were 64% and 55%, respectively. Secondary patency rates at six and 12 months were 71% and 63%, respectively. CONCLUSION: Pulse-spray pharmacomechanical thrombolysis for treatment of the thrombosed AVFs is safe, effective and durable. This procedure should be considered as an option for the management of failed AVFs prior to surgical intervention.

Keyword

Fistula, arteriovenous; Thrombolysis; Veins, transluminal angioplasty

MeSH Terms

Treatment Outcome
Treatment Failure
Thrombosis/*etiology/*prevention & control
Thrombolytic Therapy/*methods
Renal Dialysis/*adverse effects
Pulse Therapy, Drug
Middle Aged
Male
Humans
Fibrinolytic Agents/*administration & dosage
Female
Arteriovenous Shunt, Surgical/*adverse effects
Aged
Adult

Figure

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  Fig. 1 A. An angiogram of a forearm radio-cephalic arteriovenous fistula, obtained after passing a catheter into the radial artery (arrow) via a retrograde venous access, shows a long segmental occlusion at the outflow cephalic vein (arrowheads).

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  Fig. 2 A. An angiogram of an upper arm brachio-cephalic arteriovenous fistula, obtained after an antegrade puncture of the cephalic vein close to the arteriovenous anastomosis, shows an occlusion ending at the outflow cephalic vein (arrow) a few centimeters away from the anastomosis. A focal severe stenosis is also noted at the anastomosis (arrowhead).

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  Fig. 3 A graph shows primary and secondary patency rates of the thrombosed arteriovenous fistulas after percutaneous treatment using pharmacomechanical thrombolysis as the primary mode of therapy.

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