Download PDF
Semin intervent Radiol 2004; 21(2): 129-134
DOI: 10.1055/s-2004-833686
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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

Alexjandro Mendez-Castillo1 , Syed Hassain1 , Flavio Castañeda1
  • 1Radiology Department, University of Illinois College of Medicine at Peoria, Peoria, Illinois
Further Information

Publication History

Publication Date:
13 September 2004 (online)

Also available at
    Permissions and Reprints

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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Windus D W. Permanent vascular access: a nephrologist’s view.  Am J Kidney Dis. 1997;  21 457-471
    PubMedGoogle Scholar
  • 5 Munda R, First M R, Alexander J W et al.. Polytetrafluoroethylene graft survival in hemodialysis.  JAMA. 1983;  249 219-222
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 National Kidney Foundation . K/DOQI clinical guidelines for vascular access.  Am Kidney Dis. 2001;  37(suppl) S137-S181
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 16 Bookstein J J, Valji K, Roberts A C. Thrombolytic Therapy for Peripheral Vascular Disease. Philadelphia, PA; JB Lippincott 1995: 297-311
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 19 Beathard G A. Mechanical versus pharmacomechanical thrombolysis for the treatment of thrombosed dialysis access grafts.  Kidney Int. 1994;  45 1401-1406
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 22 Beathard G A. Thrombolysis versus surgery for the treatment of thrombosed dialysis access grafts.  J Am Soc Nephrol. 1995;  6 1619-1624
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 26 Chidi C C, DePalma R G. Atherogenic potential of the embolectomy catheter.  Surgery. 1978;  83 549-557
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 29 United States Renal Data System .Annual Data Report 1999. Available at www.usrds.org/adr_1999.htm
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 31 Hampton J R. Thrombolytic therapy in acute myocardial infarction.  Cardiovasc Drugs Ther. 1997;  11(suppl 1) 241-246
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar

Flavio CastañedaM.D. 

University of Illinois College of Medicine at Peoria, Department of Radiology

1 Illini Drive, Box 1649

Peoria, IL 61656

Email: flavio@miit.com