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Synthetic Dialysis Shunts: Thrombolysis with the Cragg Thrombolytic Brush Catheter¹

¹ From the Departments of Radiology (B.L.D.) and Biostatistics and Epidemiology (M.L.), Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; the Department of Radiology, St Francis Medical Center, Peoria, Ill (F.C.); the Department of Radiology, University of California Los Angeles Medical Center (T.O.M.); the Department of Radiology, Miami Vascular Institute, Miami, Fla (G.Z.); and the Department of Radiology, Fairview Riverside Medical Center, Minneapolis, Minn (A.H.C.). Supported by MicroTherapeutics, Irvine, Calif. Received March 5, 1998; revision requested May 4; revision received January 20, 1999; accepted March 25. Address reprint requests to B.L.D.

PURPOSE: To evaluate the effectiveness of the Cragg thrombolytic brush catheter for declotting of synthetic arteriovenous dialysis shunts.

MATERIALS AND METHODS: In this randomized controlled trial, 77 patients with synthetic forearm loop shunts that were thrombosed were randomly assigned to undergo pharmacomechanical thrombolysis with a pulsed spray (n = 34) or a thrombolytic brush catheter (n = 43). The following findings were evaluated: declotting time, urokinase dose, procedure time, complications, and shunt patency at the first dialysis session and at 3 months. All data were collected prospectively in an unblinded manner.

RESULTS: The total amount of urokinase used, including secondary interventions, was 243,657 IU with the catheter versus 476,563 IU with the pulsed spray (P = .001). At 15 minutes, clot lysis was successful in 66% of the patients with the catheter versus in 19% with the pulsed spray (P = .001). At 30 minutes, clot lysis was successful in 98% with the catheter versus 47% with the pulsed spray (P = .001). Procedure complication rates and patency at 3 months were similar for the catheter and the pulsed-spray groups.

CONCLUSION: Use of the Cragg catheter with urokinase offered faster and more complete clot lysis than did use of the pulsed spray with urokinase. The amount of urokinase used with the catheter was half that used with the pulsed spray. Shunt patency at 3 months was similar for the two treatment methods.

Index terms: Dialysis, shunts, 91.457 • Interventional procedures, complications, 91.44, 9.454, 91.457, 91.458 • Thrombectomy, 91.1279, 91.128 • Thrombolysis, 91.1265, 91.128

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