JOURNAL ARTICLE

Alteplase for hemodialysis access graft thrombolysis

Constantinos T Sofocleous, Clay R Hinrichs, Stanley H Weiss, Daniel Contractor, Allison Barone, Philip Bahramipour, Elias Brountzos, Dimitris Kelekis
Journal of Vascular and Interventional Radiology: JVIR 2002, 13 (8): 775-84
12171980

PURPOSE: To evaluate the efficacy and safety of alteplase, a recombinant tissue plasminogen activator, in hemodialysis access graft thrombolysis.

MATERIALS AND METHODS: From November 1999 to May 2001, 68 episodes of occlusion in 50 grafts (in 49 patients) were included in the study. Occlusion was treated with pulse-spray (n = 41) or lyse-and-wait (n = 27) thrombolysis with use of alteplase. Balloon angioplasty of all identified stenoses was performed. The arterial plug was mobilized with the Fogarty maneuver.

RESULTS: Procedural success was achieved in 64 of 68 episodes (94%) with a dose of 2-10 mg (mean = 4.13 mg) of alteplase, allowing successful hemodialysis within 24 hours. Failures (6%) were the result of PTA perforation (one of 68), nonnegotiable outflow occlusion (one of 68), delayed bleeding (one of 68), and balloon bursting and shearing becoming occlusive within the graft (one of 68). Primary and secondary patency rates were 72% and 87% at 30 days, 57% and 80% at 90 days, and 44% and 72% at 180 days, respectively. Arterial emboli (two of 68) were treated by Fogarty balloon retrieval and alteplase infusion locally over the course of 20 minutes. One of two PTA perforations was controlled by balloon tamponade.

CONCLUSION: Alteplase can be used successfully for hemodialysis graft thrombolysis.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
12171980
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.