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Radiology, Vol 154, 639-642, Copyright © 1985 by Radiological Society of North America

ARTICLES

Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy

AT Young, DW Hunter, WR Castaneda-Zuniga, SK So, S Mercado, JF Cardella and K Amplatz

Seven episodes of acute thrombosis occurring in five patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in six out of seven patients, although in one of these six, the graft reopened. The seventh patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only one patient. The authors contend that in these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creation of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.




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