fistula thrombosis fibrinolysis

Arteriovenous fistula (AVF) thrombosis is a common complication in patients undergoing hemodialysis, and early intervention is required. Urokinase has been used as a thrombolytic agent for declotting the thrombosed access. However, the optimal route for infusing urokinase remains to be determined. In the present retrospective observational study, 49 patients who underwent local venous infusion and 57 patients with peripheral venous infusion of urokinase were included. A urokinase dosage of 300,000 U was administered until successful thrombolysis, which was a maximum of three times...

Two patients with protein S deficiency with acquired multiple pial and dural arteriovenous fistulae (AVFs) following superior sagittal sinus (SSS) thrombosis are reported. Case 1 is a 38-year-old male with protein S deficiency who developed generalized seizure due to SSS thrombosis. Local fibrinolysis was achieved in the acute stage. His 10-month follow-up angiogram revealed an asymptomatic acquired dural AVF arising from the middle meningeal artery and the anterior cerebral artery with drainage to the thrombosed cortical vein in the right frontal lobe...

This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels...

PURPOSE: To assess the safety and efficacy of ultrasound (US) guidance during retrograde popliteal artery catheterization (RPAC) and identify the risk factors for late hemostasis and complications. METHODS: A retrospective review was undertaken of consecutive patients who underwent grayscale US-guided RPAC during the last 8 years. Chart review identified 174 patients (150 men; mean age 61+/-10 years, range 37-84) with 247 iliofemoral lesions, which were treated via US-guided RPAC...

Among the adverse effects possibly associated with the use of erythropoietin (EPO) in hemodialysis patients is an increased incidence of thrombosis of the vascular access. However, little is known about the effect of EPO on the stenotic lesion in the venous outflow system, which is the leading cause of fistula thrombosis. This study was designed to explore the long-term effects of EPO treatment on progressive fistula stenosis and the plasma concentrations of some potential mediators of neointimal hyperplasia...

Transport of fibrinolytic agents into thrombi represents a rate limiting step in therapeutic thrombolysis. Mathematical modeling predicts and in vitro experiments demonstrate that effective delivery of fibrinolytic agents into clots is the most important determinant of fibrinolytic rate. Transport by diffusion is slow and limited by the need for a high concentration gradient. Transport by convection is more efficient and depends on both the intrinsic resistance of the thrombus and on the effective pressure gradient...

BACKGROUND: End-stage renal disease (ESRD) patients, not uncommonly, might exhibit thrombotic complications, as well as they may present with a bleeding diathesis. Changes in vessel wall and/or blood flow in native arteriovenous fistula (AVF) might also augment these disarrangements, as vascular endothelium is predominantly involved in the regulation of haemostatic pathways. OBJECTIVE: This study was designed to evaluate the state of coagulation and fibrinolysis and the role of AVF on haemostatic defects, in ESRD patients on maintenance haemodialysis...

Over a period of 30 months (1. 1. 89-30. 6. 91) 3516 patients who had either a diagnostic (2718) or therapeutic (798) heart catheterization were followed for local vascular complications. 774 patients were investigated prospectively. The following complications were observed in declining frequency: 1. relevant haematoma, 2. pseudoaneurysm, 3. arteriovenous fistula, 4. arterial thrombosis/dissection, 5. venous thrombosis, 6. rupture of the vessel, 7. local infection. The total complication rate was 2.22%. With prospective investigation it was significantly higher (3...

BACKGROUND: In a number of haemodialyzed patients occlusion of arteriovenous fistulae for different reasons occurs. In these patients many haemocoagulation changes are described. The objective of the present work was to assess whether these occlusions are due to hypercoagulation. METHODS AND RESULTS: The investigation comprised 49 men and 32 women aged 49.3 +/- 9.3 years with renal insufficiency which had persisted for 28 +/- 17 months. Before the fistula was made, some parameters of haemocoagulation were examined...

The authors present a general review on the various techniques of interventional radiology in the treatment of vascular complications of renal transplants. Arterial stenosis require generally percutaneous transluminal angioplasty; arterial stenting is justified in cases of multiple restenosis and occluding dissection. Arterial thrombosis is treated by fibrinolysis or clot aspiration. Treatment of venous complications, such as stenosis or thrombosis, require analogous methods. Arterio-venous fistula and arterial aneurysms due to renal biopsy can be obliterated by dissection with a guide wire, or dropping of metallic coils, or electrical embolization...

Several techniques (surgical revision, thrombectomy, ...) have been described for the treatment of thrombosed vascular access (VA) in hemodialysis patients. We propose a technique with local thrombolytic infusion in conjunction with angiography and percutaneous dilatation and/or recanalization. A total of fourteen patients with twenty-two episodes of thrombosed VA was studied. Eleven patients had a Brescia-Cimino fistula and three patients had a graft fistula. We used in 21 cases urokinase (243000 UI +/- 100000 UI) and in 1 case rt-PA (50 mg)...

PURPOSE: Occlusive iliofemoral venous thrombosis is associated with morbid short- and long-term consequences. Having been disappointed with standard anticoagulant therapy and systemic fibrinolysis, we embarked on an aggressive multidisciplinary regional approach to treat these patients, with the goals of therapy being (1) to eliminate iliofemoral venous thrombus, (2) to provide unobstructed venous drainage from the affected limb, and (3) to prevent recurrent thrombosis. METHODS: Twelve consecutive patients were treated for extensive iliofemoral venous thrombosis...

Although endogenous fistulae and grafts are preferred for permanent hemodialysis access, central venous catheters are often required for varying intervals when creating permanent access is not feasible. The prospective experience with 118 catheters in over a 3.5-yr period is reported; 93 (79%) were placed by percutaneous techniques, and 25 (21%) were placed by operative techniques. Seventy seven catheters (65%) were placed in the subclavian vein, 36 (31%) were placed in the internal jugular vein (usually right side), and 5 (4%) were placed in the femoral vein...

Thirteen women of fertile age with left-sided iliofemoral venous thrombosis were treated with thrombectomy and a temporary arteriovenous fistula in the groin. In nine patients, the appearance of thrombosis could be related to pregnancy; in three of these, obstetric complications occurred. Diagnosis was obtained by antegrade and retrograde phlebography. After three months, the arteriovenous fistula was closed. Anticoagulant treatment was given from the time of diagnosis and for a total of six months. Patency of the iliac vein was determined by phlebography or venous occlusion plethysmography, or both...

Streptokinase was selectively infused into nine thrombosed hemodialysis access fistulas in eight patients. Lysis occurred in all but one case. Of the eight infusions producing lysis, seven resulted in some clinical benefit. Three grafts functioned adequately for 2 to 6 months after streptokinase infusion alone. A fourth patient had good function for over 11 months after streptokinase treatment and transluminal angioplasty. In a fifth patient, graft function was partially restored, but a persistent arterial defect led to elective graft replacement...

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We reviewed the results, systemic effects, and complications associated with the selective infusion of low-dose streptokinase in 151 patients. Successful thrombus lysis was achieved in 78% of atherosclerotic thrombotic occlusions less than 30 days old, in 81% of post-procedural occlusions less than 14 days old, and in 87% of patients with thrombosed arteriovenous fistulas no more than 4 days old. During the first 12 hours of treatment 81% to 84% of patients had greater than 50% decrease in plasma fibrinogen levels and 100% showed the same decline after 24 hours of treatment...

To evaluate the role of selective intra-arterial low-dose thrombolytic therapy (SILDT) as an alternative to the surgical management of acute arterial occlusion, the hospital records of 40 patients who underwent 43 SILDT treatments with either streptokinase (36) or urokinase (7) between December 1979 and March 1984 were reviewed. Twenty-eight patients underwent 30 treatments (group 1) for native arterial occlusion and 12 patients underwent 13 treatments (group 2) for prosthetic or autogenous graft occlusions...

The patency of vascular access shunts and fistulae has been prolonged by a combined surgical and radiological approach that includes percutaneous transluminal angioplasty (PTA), surgical revision, thrombectomy, and thrombolysis. Over the last 3 years, 35 vascular accesses in 27 patients were found to have angiographic abnormality. PTA was performed 32 times on 19 accesses and 7 PTAs resulted in patent accesses by the end of the study. Surgical revision was performed 9 times on 8 accesses and 2 of the surgical revisions resulted in a patent access by the end of the study...

Twenty patients, submitted to internal arteriovenous fistula procedure, were randomly assigned to one of the following treatments: defibrotide 400 mg b.i.d. IM (starting the day before surgery and continuing for the following 7 days); calcium heparin 5,000 IU t.i.d. SC (since the day of surgery and for the following 7 days). No deep venous thrombosis or thrombosis of the fistula were noticed during both treatments and no side effects were observed. In the defibrotide group, ELT showed a significant decrease (-40%) attesting an improvement of fibrinolysis without a plasminogen abatement...