Pharmacomechanical Thrombolysis of Dialysis Access Grafts Using the MTI Castañeda Over-the-Wire Brush Catheter and Reteplase

Pharmacomechanical thrombolysis (PMT) has emerged as an alternate treatment used in most patients presenting with a thrombosed hemodialysis graft. Although the gold standard, surgical revision of thrombosed hemodialysis grafts is reserved for those cases of recurrent thrombosis despite the use of percutaneous techniques and for complicated cases after PMT. Nevertheless, as for every other procedure, PMT has its own set of limitations and cost issues. New mechanical devices have begun to emerge on the market to help accelerate clot dissolution with or without thrombolytic medications. These devices have decreased the time required to lyse clot and decrease the overall cost of percutaneous treatment. This article describes the use of the Microtherapeutics, Inc. (MTI) Castañeda over-the-wire brush and our experience with this device in the treatment of the clotted hemodialysis graft.

KEYWORDS

Dialysis - thrombolysis - intervention

REFERENCES

• 1 Treatment modalities for ESRD patients . USEDS. United States Renal Data System.  Am J Kidney Dis. 1997;  30(suppl 1) S54-S66
• 2 Feldman H I, Held P J, Hutchinson J T et al.. Hemodialysis vascular access morbidity in the United States.  Kidney Int. 1993;  43 1091-1096
• 3 The economic cost of ESRD . Vascular access procedures, and Medicare spending for alternative modalities of treatment. USRDS. United States Renal Data System.  Am J Kidney Dis. 1997;  30(suppl 1) S160-S177
• 4 Windus D W. Permanent vascular access: a nephrologist’s view.  Am J Kidney Dis. 1997;  21 457-471
• 5 Munda R, First M R, Alexander J W et al.. Polytetrafluoroethylene graft survival in hemodialysis.  JAMA. 1983;  249 219-222
• 6 Tellis V A, Kohlberg W I, Bhat D J et al.. Expanded polytetrafluoroethylene grafts fistula for chronic hemodialysis.  Am Surg. 1979;  189 101-103
• 7 Schwartz C I, McBrayer C V, Sloan J H et al.. Thrombosed dialysis grafts: comparison of treatment with transluminal angioplasty and surgical revision.  Radiology. 1995;  194 337-341
• 8 Kanterman R Y, Vesely T M, Pilgram T K et al.. Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty.  Radiology. 1995;  195 135-139
• 9 National Kidney Foundation . K/DOQI clinical guidelines for vascular access.  Am Kidney Dis. 2001;  37(suppl) S137-S181
• 10 Turmel-Rodrigues L, Pengloan J, Blancher D et al.. Insufficient dialysis shunts: improved long-term patency rates with close hemodynamic monitoring, repeat percutaneous balloon angioplasty, and stent placement.  Radiology. 1993;  187 273-278
• 11 Glanz S, Gordon D H, Butt K M et al.. The role of percutaneous angioplasty in the management of chronic hemodialysis fistulas.  Am Surg. 1987;  206 777-781
• 12 Schwab S J, Raymond J R, Saeed M et al.. Prevention of hemodialysis fistula thrombosis early detection of venous stenoses.  Kidney Int. 1989;  36 707-711
• 13 Marston W A, Criado E, Jaques P F et al.. Prospective randomized comparison of surgical versus endovascular management of thrombosed dialysis grafts.  J Vasc Surg. 1997;  26 373-381
• 14 Brooks S J, Sigley R D, May K J et al.. Transluminal angioplasty versus repair for stenoses of hemodialysis grafts.  Am J Surg. 1987;  153 530-531
• 15 National Kidney Foundation. Dialysis Outcomes Quality Initiative . (DOQI). Clinical Practice Guidelines for Vascular Access: Update 2000. Guideline 21-Treatment of Thrombosis and Associated Stenosis in Dialysis AV Grafts.  , Availabel at www.kidney.org/professionals/kdoqi/guidelines_updates/doqu_uptoc.html
• 16 Bookstein J J, Valji K, Roberts A C. Thrombolytic Therapy for Peripheral Vascular Disease. Philadelphia, PA; JB Lippincott 1995: 297-311
• 17 Gray R J, Sacks D, Martin L G, Trerotola S O. Reporting standards for percutaneous interventions in dialysis access. Technology Assessment Committee.  J Vasc Interv Radiol. 1999;  10 1405-1415
• 18 Dolmatch B L, Castañeda F, McNamara T O et al.. Synthetic dialysis shunts: thrombolysis with the Cragg thrombolytic brush catheter.  Radiology. 1999;  213 180-184
• 19 Beathard G A. Mechanical versus pharmacomechanical thrombolysis for the treatment of thrombosed dialysis access grafts.  Kidney Int. 1994;  45 1401-1406
• 20 Middlebrook M R, Amygdalos M A, Soulen M C et al.. Thrombosed hemodialysis grafts: percutaneous mechanical balloon declotting versus thrombolysis.  Radiology. 1995;  196 73-77
• 21 Trerotola S O, Lund G B, Scheel Jr P J et al.. Thrombosed dialysis access grafts: percutaneous mechanical declotting without urokinase.  Radiology. 1994;  191 721-726
• 22 Beathard G A. Thrombolysis versus surgery for the treatment of thrombosed dialysis access grafts.  J Am Soc Nephrol. 1995;  6 1619-1624
• 23 Kinney T B, Valji K, Rose S C et al.. Pulmonary embolism from pulse-spray pharmacomechanical thrombolysis of clotted hemodialysis grafts: urokinase versus heparinized saline.  J Vasc Interv Radiol. 2000;  11 1143-1152
• 24 Castañeda F, Li R, Patel J et al.. Comparison of three mechanical thrombus removal devices in thrombosed canine iliac arteries.  Radiology. 2001;  219 153-156
• 25 Lajvardi A, Trerotola S O, Strandberg J D, Samphilipo M A, Magee C. Evaluation of venous injury caused by a percutaneous mechanical thrombolytic device.  Cardiovasc Intervent Radiol. 1995;  18 172-178
• 26 Chidi C C, DePalma R G. Atherogenic potential of the embolectomy catheter.  Surgery. 1978;  83 549-557
• 27 Walker L N, Ramsay M M, Bowyer D E. Endothelial healing following defined injury to rabbit aorta. Depth of injury and mode of repair.  Atherosclerosis. 1983;  47 123-130
• 28 Grunwald J, Haudenschild C C. Intimal injury in vivo activates vascular smooth muscle cell migration and explant outgrowth in vitro.  Arteriosclerosis. 1984;  4 183-188
• 29 United States Renal Data System .Annual Data Report 1999. Available at www.usrds.org/adr_1999.htm
• 30 Cohen M A, Kumpe D A, Durham J D, Zwerdlinger S C. Improved treatment of thrombosed hemodialysis access sites with thrombolysis and angioplasty.  Kidney Int. 1994;  46 1375-1380
• 31 Hampton J R. Thrombolytic therapy in acute myocardial infarction.  Cardiovasc Drugs Ther. 1997;  11(suppl 1) 241-246
• 32 Boersma E, Steyerberg E W, Van der Vlugt M J, Simoons M L. Reperfusion therapy for acute myocardial infarction. Which strategy for which patient?.  Drugs. 1998;  56 31-48