Abstract
Background/aim It was aimed to describe the technical aspects and outcomes of percutaneous ultrasound-guided recanalization of thrombosed hemodialysis fistulas by thrombolytic injection.Materials and methods A retrospective review was performed on patients with thrombosed native hemodialysis fistula who were treated using the percutaneous ultrasound-guided thrombolytic agent injection technique at the interventional radiology department. A total of 17 patients [7 women (41.2%) and 10 men (58.8%)] were included in this study. All of the data, including demographic information and clinical findings, were obtained from the patients’ medical records and follow-up form of the procedure.Results The mean fistula age was 5.6 years (range: 1–15 years). The mean diameter of the thrombosed segment was 5.53 cm (2–10 cm). Localization of the thrombi was in the aneurysmal segment at the level of needle insertion in 64.7% (n: 11) of patients, while it was on the venous side of the anastomosis in 35.3% (n: 6). The mean dose of tissue plasminogen activator (tPA) used in all of the sessions was 8.88 mg (5–17 mg). Overall technical success after all of the administrations was 100% and clinical success was 94.1%.Conclusion Percutaneous ultrasound-guided thrombolytic injection in native hemodialysis fistulas is a rapid, practical, repeatable treatment method that is received on an outpatient basis with low risk of bleeding, and prevents unnecessary endovascular interventions or surgical operations.
Highlights
Chronic kidney disease (CKD) is an important health problem affecting people worldwide by virtue of high morbidity and mortality
Percutaneous ultrasound-guided thrombolytic injection in native hemodialysis fistulas is a rapid, practical, repeatable treatment method that is received on an outpatient basis with low risk of bleeding, and prevents unnecessary endovascular interventions or surgical operations
Diagnosis and endovascular treatment in the dysfunction of hemodialysis fistulae and grafts have been successfully performed by interventional radiologists over the last decades
Summary
Chronic kidney disease (CKD) is an important health problem affecting people worldwide by virtue of high morbidity and mortality. Due to developing dialysis technology and therapies, the life-span and quality of life in patients undergoing hemodialysis with CKD is increased. Native arteriovenous fistula (AVF), synthetic loop grafts, and large-bore tunneled or temporary central venous catheters are the alternative hemodialysis methods for patients who cannot undergo renal transplant [1,2]. Among these options, native AVF is the first and most durable choice for vascular access because of the lower thrombotic and infectious complications [1,3]. Thrombosis is one of the most severe complications and is influential to morbidity and hospitalization in hemodialysis patients [4].
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