Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(03): 244-245
DOI: 10.4103/0971-3026.161442
Vascular and Interventional Radiology

USG-guided needle-directed pulse-spray pharmaco-mechanical thrombolysis of hemodialysis grafts/fistula: A novel technique

KS Amitha Vikrama
Department of Interventional Radiology, Sakra World Hospital, Bangalore, Karnataka, India
,
N Srivalli
Department of Radiology, Apollo Hospitals, Bangalore, Karnataka, India
,
Venkataramana S Raju
Department of Nephrology, Apollo Hospitals, Bangalore, Karnataka, India
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
Also available at
  PDF Download Permissions and Reprints

Abstract

The incidence of end-stage renal disease is significantly increasing and most patients who require renal transplantation are undergoing hemodialysis through tunneled/non-tunneled dialysis catheters and arteriovenous fistulas. The greatest disadvantage of the hemodialysis access is  the limited durability of the arteriovenous fistulas and grafts, which, on average, remain patent for <3 years, but are the lifeline for hemodialysis patients. Catheter-directed interventions are successful in re-establishing flow in more than 80% of thrombosed hemodialysis fistulas and have become the treatment of choice for failing or thrombosed accesses. However, these interventions are expensive and require a tertiary center with well-equipped labs. The novel technique of needle-directed thrombolysis is less expensive and can be done on an OPD basis in any primary healthcare setup. To the extent we have searched, no such technique has been published so far in the English literature.

Keywords

Hemodialysis fistula - thrombolysis - USG-guided procedure


Publication History

Article published online:
30 July 2021

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Cooper SG. Original report. Pulse-spray thrombolysis of thrombosed hemodialysis grafts with tissue plasminogen activator. AJR Am J Roentgenol 2003;180:1063-6.
  • 2 Bookstein JJ, Fellmeth B, Roberts A, Valji K, Davis G, Machado T. Pulsed-spray pharmacomechanical thrombolysis: Preliminary clinical results. AJR Am J Roentgenol 1989;152:1097-100.
  • 3 Valji K, Bookstein JJ, Roberts AC, Oglevie SB, Pittman C, O′Neill MP. Pulse-spray pharmacomechanical thrombolysis of thrombosed hemodialysis access grafts: Long-term experience and comparison of original and current techniques. AJR Am J Roentgenol 1995;164:1495-503.