Ultrasound-accelerated thrombolysis: an innovative technique to treat native arteriovenous fistula acute thrombosis

Abstract

Native arteriovenous fistula (AVF) acute thrombosis is the first cause of vascular access failure. Different procedures can restore AVF patency: pharmacological thrombolysis, mechanical thrombolysis and surgical thrombectomy. At the same time vascular stenosis must always be found and treated by angioplasty. Direct thrombolysis with endovascular catheter with or without mechanical thrombolysis is becoming the treatment of first choice. Ultrasound-accelerated thrombolysis by the EkoSonic Endovascular System (EKOS) is an innovative technique: a multilumen catheter releases low-dose ultrasound energy in addition to thrombolytic infusion inside the thrombus. EKOS thrombolysis is faster, more effective and less dangerous than standard thrombolysis. This technique brings neither thrombus fracture or breakage nor hemolysis, so it is better than mechanical thrombolysis. Ultrasound-accelerated thrombolysis is used to treat acute arterious and deep venous thrombosis and massive pulmonary thromboembolism. We first used microsonic accelerated thrombolysis to treat a 20 cm long thrombosis of a distal radio-cephalic fistula involving the forearm superficial venous circle. EKOS® system permitted a rapid resolution of vein thrombosis, restored the forearm superficial venous circle patency without any injury and allowed an immediate use of the AVF for dialysis. After 15 months, the AVF is still patent and well functioning.