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Urokinase thrombolysis in hemodialysis vascular access

Hans Van Der Meersch, Dirk De Bacquer, Stefaan J Vandecasteele, Barbara Van den Bergh, Pieter Vermeiren, Jan De Letter, An S De Vriese
BACKGROUND: A complication of long-term use of tunneled cuffed catheters for hemodialysis is the high rate of infection and thrombus-related dysfunction. Specific mechanical features of tunneled cuffed catheters may improve hemodynamic performance and decrease thrombosis and infection rates. However, there currently is no proven advantage of one design over another. STUDY DESIGN: Single-center randomized clinical trial. SETTING & PARTICIPANTS: 302 hemodialysis patients who required a tunneled cuffed catheter as temporary or definite vascular access...
December 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Huei-Lung Liang, Huay-Ben Pan, Yih-Huie Lin, Chiung-Yu Chen, Hsiao-Min Chung, Tung-Ho Wu, Kang-Ju Chou, Pin-Hong Lai, Chien-Fang Yang
OBJECTIVE: We wanted to report our experience of metallic stent placement after insufficient balloon dilation in graft hemodialysis patients. MATERIALS AND METHODS: Twenty-three patients (13 loop grafts in the forearm and 10 straight grafts in the upper arm) underwent metallic stent placement due to insufficient flow after urokinase thrombolysis and balloon dilation. The indications for metallic stent deployment included 1) recoil and/or kinked venous stenosis in 21 patients (venous anastomosis: 17 patients, peripheral outflow vein: four patients); and 2) major vascular rupture in two patients...
April 2006: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
William D Haire, Steven R Deitcher, Kathleen M Mullane, Michael R Jaff, Carolyn M Firszt, Gregory A Schulz, Debra M Schuerr, Lewis B Schwartz, Tamyra L Mouginis, R Phillip Barton
The interval occlusion of central venous access devices (CVADs) remains a significant clinical problem, often requiring re-intervention for catheter exchange or replacement. The purpose of this Phase 3, multi-center, double-blinded study was to test the hypothesis that instillation of recombinant urokinase (r-UK) 5000 IU/ml is superior to placebo in restoring total catheter patency to an unselected cohort of occluded CVADs. After obtaining informed consent, adult and pediatric patients with occluded, non-hemodialysis CVADs of any duration or type were randomized (2 : 1) to receive either r-UK 5000 IU/ml or placebo instilled into all occluded lumens of their catheter...
September 2004: Thrombosis and Haemostasis
Constantinos T Sofocleous, Israel Schur, Elsie Koh, Clay Hinrichs, Stanley G Cooper, Adam Welber, Elias Brountzos, Dimitris Kelekis
INTRODUCTION/OBJECTIVE: To describe and evaluate percutaneous treatment methods of complications occurring during recanalization of thrombosed hemodialysis access grafts. METHODS AND MATERIALS: A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade, eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal angina, one procedural death, and one distant hematoma...
September 2003: European Journal of Radiology
P Anain, S Shenoy, M O'Brien-Irr, L M Harris, M Dryjski
PURPOSE: To retrospectively review the long-term outcome as well as the cost effectiveness of thrombolytic therapy and balloon angioplasty (TBA) versus surgical thrombectomy and balloon angioplasty (SBA) in the treatment of prosthetic dialysis access grafts. METHODS: Between February 1996 and February 1999, 63 hemodialysis patients (35 women; mean age 62.2 years) were treated for 105 thromboses in 6-mm polytetrafluoroethylene straight or loop bridge arteriovenous grafts...
April 2001: Journal of Endovascular Therapy
D Schon, R Mishler
Well-functioning vascular access is essential to optimizing outcomes in hemodialysis patients. Initial placement of greater numbers of autologous arteriovenous fistulae (AVFs) is needed, as is more attention to salvage of such accesses when they become occluded. In this study, thrombolysis with small doses of thrombolytic agents in combination with balloon angioplasty was attempted in 15 patients with 16 autologous AVFs (7 forearm AVFs, 8 upper-arm AVFs). Either urokinase (UK; mean dose, 109,375 U) or tissue plasminogen activator (tPA; mean dose, 7...
October 2000: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
M J Dougherty, K D Calligaro, N Schindler, C A Raviola, A Ntoso
PURPOSE: The objective of this study was to compare clinical outcome and costs for two widely used treatment strategies for hemodialysis graft thrombosis. METHODS: During a 4-year period, 80 patients with thrombosed dialysis grafts were randomly assigned to surgical thrombectomy with or without graft revision (SURG) or thrombolytic therapy with urokinase with the pulse-spray technique (ENDO), with adjunctive percutaneous transluminal angioplasty as indicated. All the procedures were performed in an endovascular operating suite with fistulography...
December 1999: Journal of Vascular Surgery
J D Petronis, F Regan, G Briefel, P M Simpson, J M Hess, C S Contoreggi
The objective of this study is to determine, by using rigorous methods, if pulmonary perfusion defects were detectable by ventilation-perfusion scintigraphy after percutaneous thrombolysis of clotted hemodialysis access grafts. Thirteen patients were studied. Four patients underwent pharmacomechanical thrombolysis with urokinase and the remainder had mechanical thrombolysis alone. Pre- and postthrombolysis scintigraphic studies were performed on all patients. Perfusion defects were described as vascular (well-defined borders confined to segmental boundaries) or nonvascular...
August 1999: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
R I Patel, S H Peck, S G Cooper, D M Epstein, C T Sofocleous, I Schur, A Falk
PURPOSE: To determine the patency of Wallstents placed across the venous anastomosis of prosthetic bridge grafts after percutaneous graft recanalization. MATERIALS AND METHODS: Wallstents were placed across 26 lesions at the venous anastomosis of polytetrafluoroethylene (PTFE) grafts in 25 patients (11 men, 14 women; age range, 29-83 years; mean age, 65.4 years) after pulse-spray pharmacomechanical thrombolysis. Indications for stent deployment included acute angioplasty failure, rapid restenosis, and vessel perforation...
November 1998: Radiology
S O Trerotola, T M Vesely, G B Lund, M C Soulen, K O Ehrman, J F Cardella
PURPOSE: To evaluate a percutaneous thrombolytic device (PTD) designed for treating thrombosed hemodialysis access grafts. MATERIALS AND METHODS: To compare the PTD with pulse-spray pharmacomechanical thrombolysis (PSPMT) by using urokinase, 122 randomly chosen patients with synthetic, thrombosed hemodialysis access grafts from multiple centers prospectively underwent thrombolysis with the PTD (5-F, low-speed rotational mechanical device) or PSPMT. Major outcome variables included the procedure time, the immediate technical patency rate, the complication rate, and the 3-month patency rate...
February 1998: Radiology
A C Roberts, K Valji, J J Bookstein, R J Hye
The results of pulse-spray pharmacomechanical thrombolysis (PSPMT) of 209 thrombosed hemodialysis grafts were reviewed. In PSPMT, concentrated urokinase is injected forcefully through catheters with multiple tiny sideholes or sideslits. Catheters placed in a crisscross fashion cover the entire clot simultaneously. This therapy was successful in treating patients with thrombosed grafts. Of the 200 grafts with complete therapy, 197 grafts (99%) were patent at the end of the procedure. Mean time for pulsed-spray lysis was 40 minutes...
August 1993: American Journal of Surgery
E Schuman, S Quinn, B Standage, G Gross
Graft thrombosis is the most frequent complication of polytetrafluoroethylene grafts for hemodialysis. Many of these patients arrive at the dialysis unit with fluid and metabolic abnormalities that require prompt dialysis. Rapid declotting of the graft is important to avoid having to create temporary access. Thrombolysis with urokinase has been evaluated by recent retrospective studies and found to be successful in 60% to 90% of cases. Our prospective, randomized trial was initiated to compare thrombolysis with standard surgical thrombectomy; and to evaluate the safety, effectiveness, efficiency, and durability of these modalities...
May 1994: American Journal of Surgery
M A Cohen, D A Kumpe, J D Durham, S C Zwerdlinger
We treated percutaneously 135 expanded polytetrafluoroethylene (PTFE) prosthetic grafts which had thrombosed using thrombolysis with urokinase followed by balloon angioplasty. Functional patency was re-established in 38 of 62 (61%) using single catheter technique, and in 62 of 73 (85%) using crossed catheter technique (P < 0.01). Hemorrhagic complications were reduced from 12.9% in the single catheter technique to 1.4% in the crossed catheter technique (P < 0.01). Median "primary patency after treatment" of the PTFE accesses after successful restoration of function was 98 days...
November 1994: Kidney International
K Valji, J J Bookstein, A C Roberts, S B Oglevie, C Pittman, M P O'Neill
OBJECTIVE: Pulse-spray pharmacomechanical thrombolysis is an evolving method for the treatment of vascular occlusions in which a highly concentrated fibrinolytic agent is injected as a high-pressure spray directly into thrombus. The purpose of this retrospective study was to analyze our long-term experience with this technique for the treatment of clotted hemodialysis grafts and to compare the efficacy and safety of the original and current methods. SUBJECTS AND METHODS: Over 6 years, 284 cases of dialysis graft thrombosis were considered suitable for treatment with pulse-spray thrombolysis...
June 1995: AJR. American Journal of Roentgenology
J J Schilling, A R Eiser, R F Slifkin, J T Whitney, M S Neff
Thirty-eight occluded hemodialysis accesses were infused with urokinase on 43 occasions. In 49% of the cases, the access patency was reestablished for a week or longer, although 38% of this subset subsequently rethrombosed. Postthrombolysis angiography detected a stenotic segment in 14 of 22 angiograms (64%). Local bleeding was common, but the thrombolytic therapy was generally well tolerated. Percutaneous thrombolysis in conjunction with angiography and access revision provides a clinically useful means of access preservation...
August 1987: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
A Ortensia, M Delle Volpe, M Iberti, G V Veronesi, G De Micheli
Pharmacological treatment with urokinase in obstructions of vascular accesses due to chronic dialysis is a tried and tested technique. Retrospective investigation of a group of 111 cases treated with urokinase makes it possible to calculate the actuarial survival curve of vascular access in the period subsequent to fibrinolytic treatment. Mathematical analysis provides a precise indication to the use of the drug in thromboses of a-v fistulas and anatomically unimpaired vascular prothesies. In the presence of stenosis of a-v anastomosis, pharmacological thrombolysis permits restoration of a blood flow suitable to the conduction of haemodialytic treatment for a period useful to surgical correction...
January 1990: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
F Poulain, A Raynaud, P Bourquelot, C Knight, X Rovani, J C Gaux
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.
March 1991: Cardiovascular and Interventional Radiology
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