Transcatheter treatment of thrombosed hemodialysis access grafts

Thrombosis of access grafts is a frequent problem for patients being treated with long-term hemodialysis. Transcatheter techniques have recently been used in the primary management of failed dialysis grafts. This article reviews current methods for transcatheter treatment. Several thrombolytic techniques are discussed, including pharmacologic, pharmacomechanical, and mechanical methods. Methods for treatment of underlying graft stenosis are considered. Complications associated with these procedures are reviewed. The percutaneous techniques are compared among themselves and with standard surgical procedures for graft revision. Finally, several evolving methods for prevention of dialysis graft thrombosis are considered.