Subject(s)
Crohn Disease/surgery , Mesenteric Veins , Portal Vein , Postoperative Complications/surgery , Prothrombin/genetics , Thrombectomy/instrumentation , Venous Thrombosis/surgery , Adult , Crohn Disease/complications , Female , Humans , Postoperative Complications/etiology , Reoperation , Thrombectomy/methods , Venous Thrombosis/etiology , Venous Thrombosis/geneticsABSTRACT
PURPOSE: To prospectively evaluate the efficacy and safety of reteplase with percutaneous transluminal angioplasty (PTA) in the treatment of thrombosed polytetrafluoroethylene hemodialysis arteriovenous grafts (AVGs). MATERIALS AND METHODS: Forty-two patients were entered into the study. Sixty-two procedures in 43 grafts were performed. One unit of reteplase and 4,000 units of heparin were administered into the AVGs. Routine venography and percutaneous transluminal angioplasty (PTA) was then performed. Patients were transferred for hemodialysis immediately after the procedure. RESULTS: Technical success was achieved in 92% of the cases. Four cases involved intentional repeat thrombosis because of poor outflow and/or need for a new graft site. Minor complications occurred in 6.5% of the cases. No major complications occurred. The mean procedure time for experienced versus less-experienced interventionalists was significantly shorter (P <.001). Primary patency rates were 50%, 34%, and 34% at 30, 90, and 180 days, respectively. CONCLUSION: Reteplase in conjunction with heparin and PTA is a safe and effective means of thrombolysis of AVGs. Its efficacy is comparable to that of other available thrombolytic drugs.
Subject(s)
Fibrinolytic Agents/therapeutic use , Graft Occlusion, Vascular/drug therapy , Recombinant Proteins/therapeutic use , Renal Dialysis , Thrombosis/drug therapy , Tissue Plasminogen Activator/therapeutic use , Adult , Aged , Aged, 80 and over , Angioplasty, Balloon , Blood Vessel Prosthesis , Female , Graft Occlusion, Vascular/therapy , Heparin/therapeutic use , Humans , Male , Middle Aged , Polytetrafluoroethylene , Prospective Studies , Statistics, Nonparametric , Thrombolytic Therapy , Thrombosis/therapy , Treatment Outcome , Vascular PatencyABSTRACT
A patient with acute type B dissection and a tube configuration of the intimal flap presented with signs of advanced mesenteric and renal ischemia as well as decreased pulses in the lower extremities. The patient was referred for emergency percutaneous fenestration of the abdominal aorta as a salvage procedure and a possible bridge to later surgery. After fenestration, femoral pulses became transiently stronger and then disappeared. The patient died after exploratory laparotomy. Postmortem examination demonstrated dehiscence of the infrarenal abdominal aortic intima with occlusion of the aortic bifurcation.
Subject(s)
Aorta, Abdominal/injuries , Aortic Aneurysm/complications , Aortic Dissection/complications , Catheterization/adverse effects , Ischemia/therapy , Acute Disease , Aortic Dissection/diagnostic imaging , Aortic Aneurysm/diagnostic imaging , Fatal Outcome , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Kidney/blood supply , Leg/blood supply , Male , Mesentery/blood supply , Middle Aged , Radiography, InterventionalABSTRACT
PURPOSE: To evaluate prospectively the efficacy of treating thrombosed hemodialysis arteriovenous polytetrafluoroethylene (PTFE) grafts using tissue-type plasminogen activator (tPA) and percutaneous transluminal angioplasty (PTA). MATERIALS AND METHODS: Forty-two sequential thrombosed PTFE dialysis grafts in 33 patients presented for declotting. All 42 grafts were treated with a modified lysis and PTA technique with use of 2 mg tPA and 3,000-5,000 U heparin in a total volume of 5 mL, administered into the graft via an angiocatheter. The elapsed time from tPA injection until completion was recorded. Prospective data collection included demographic information, technical details of the procedure, immediate outcomes, complications, and patency rates. RESULTS: Technical success, defined as complete graft recanalization with a palpable thrill after treatment plus successful hemodialysis, was achieved in all cases, except five. These five cases were deliberate graft closures due to inadequacy of the outflow veins to support an arteriovenous graft after successful lysis. Mean lysis time was 40.8 minutes and mean room procedure time after the lysis period was 65.4 minutes. Eight procedure-related complications occurred (two major and six minor). The follow-up period was 4-241 days, with an estimated mean of 157 days. The 30-day and 90-day primary patency rates were 57% and 50%, respectively. CONCLUSIONS: Treatment of thrombosed PTFE dialysis grafts with use of 2 mg tPA and 3,000 U of heparin is safe and effective. Use of this modified lysis and PTA technique allows an expeditious procedure in the angiography suite. However, this technique precludes imaging of the outflow veins before treatment, so that grafts entering diffusely diseased veins may need to be closed after successful lysis.