Reteplase in the treatment of thrombosed hemodialysis grafts

A Falk, J Guller, F S Nowakowski, H Mitty, V Teodorescu, J Uribarri, J Vassalotti
Journal of Vascular and Interventional Radiology: JVIR 2001, 12 (11): 1257-62

PURPOSE: To prospectively evaluate the efficacy and safety of reteplase with percutaneous transluminal angioplasty (PTA) in the treatment of thrombosed polytetrafluoroethylene hemodialysis arteriovenous grafts (AVGs).

MATERIALS AND METHODS: Forty-two patients were entered into the study. Sixty-two procedures in 43 grafts were performed. One unit of reteplase and 4,000 units of heparin were administered into the AVGs. Routine venography and percutaneous transluminal angioplasty (PTA) was then performed. Patients were transferred for hemodialysis immediately after the procedure.

RESULTS: Technical success was achieved in 92% of the cases. Four cases involved intentional repeat thrombosis because of poor outflow and/or need for a new graft site. Minor complications occurred in 6.5% of the cases. No major complications occurred. The mean procedure time for experienced versus less-experienced interventionalists was significantly shorter (P <.001). Primary patency rates were 50%, 34%, and 34% at 30, 90, and 180 days, respectively.

CONCLUSION: Reteplase in conjunction with heparin and PTA is a safe and effective means of thrombolysis of AVGs. Its efficacy is comparable to that of other available thrombolytic drugs.

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