fistula thrombosis fibrinolysis

Sixty-four thrombosed hemodialysis fistulas in 55 patients were treated by local low-dose infusion of urokinase, percutaneous angioplasty, and thromboaspiration. Lysis was initially successful in 38 cases (59%) without any negative side effects. At 1 year, 59% of these fistulas were still functional. When the procedures failed, surgery saved the vascular access in 17 cases. Local fibrinolysis combined with thromboaspiration and angioplasty provides a clinically useful means of access preservation.

Coronary artery-cardiac fistulae are uncommon and usually congenital abnormalities. The majority of these fistulae communicate with the right heart chambers. Acquired coronary-left heart fistulae are very rare: secondary to trauma, cardiac surgery, angioplasty or endomyocardial biopsy. Fistulae secondary to myocardial infarction are rare but have been described. The authors report the case of a man with anterior wall infarction treated by fibrinolysis and by angioplasty of the left anterior descending artery (LAD) 48 hours later...

Thromboembolism might complicate the treatment of patients with chronic renal failure with Recombinant Human Erythropoietin (ReHuEPO). In order to detect prothrombotic changes, a number of hemostatic and fibrinolytic parameters was determined during ReHuEPO treatment of fifteen chronic hemodialysis patients (mean age 47.1 years; ten females, five males). To avoid the influence of hemoconcentration and/or dilution, the patients were kept normovolemic, using the method of echography of the inferior vena cava diameter...

Indications for thrombectomy in acute thrombosis of the deep veins of the pelvis and lower extremities are: 1. Phlegmasia coerulea dolens with imminent danger of venous gangrene. 2. All cases: a) with contraindications for a therapy with fibrinolysis, b) after therapy-failures with thrombolytic therapy, c) thrombosis of more than 3 days duration. 3. In cases associated with tumours or trauma. If a thrombectomy can only be partially achieved, or in cases with an old thrombosis, a temporary arteriovenous fistula is performed...

The only effective causal therapy in thromboses of the deep pelvic and femoral veins is fibrinolysis or operative thrombectomy. Concerning the contraindications, fibrinolysis is successful only up to the 5th day. After that time patients with deep vein thrombosis were submitted to thrombectomy and at the same time, to prevent renewed thrombosis secondary to a slowing down of the flow, a peripheral arteriovenous fistula was temporarily positioned. Between 1974 and 1976, 14 patients were treated operatively this way...

In acute iliofemoral vein thrombosis thrombectomy with a temporary AV-fistula is an alternative treatment to induced fibrinolysis and anticoagulation. Reviewing our results we have found an extremely high incidence of wound infections. In 36 patients thrombectomy with temporary AV-fistula has been performed. 31% of these had a postoperative wound infection. The mean hospital stay for the infected patients was 25 days compared to 10 days for the non-infected patients. In 26 patients a second, elective operation with closure of the AV-fistula was performed...