A promising method for the salvage of thrombosed native hemodialysis fistulas: percutaneous ultrasound-guided thrombolytic injection

Background/aim: It was aimed to describe the technical aspects and outcomes of percutaneous ultrasound-guided recanalization ofthrombosed hemodialysis fistulas by thrombolytic injection.Materials and methods: A retrospective review was performed on patients with thrombosed native hemodialysis fistula who weretreated using the percutaneous ultrasound-guided thrombolytic agent injection technique at the interventional radiology department.A total of 17 patients [7 women (41.2%) and 10 men (58.8%)] were included in this study. All of the data, including demographicinformation and clinical findings, were obtained from the patients’ medical records and follow-up form of the procedure.Results: The mean fistula age was 5.6 years (range: 1–15 years). The mean diameter of the thrombosed segment was 5.53 cm (2–10 cm).Localization of the thrombi was in the aneurysmal segment at the level of needle insertion in 64.7% (n: 11) of patients, while it was onthe venous side of the anastomosis in 35.3% (n: 6). The mean dose of tissue plasminogen activator (tPA) used in all of the sessions was8.88 mg (5–17 mg). Overall technical success after all of the administrations was 100% and clinical success was 94.1%.Conclusion: Percutaneous ultrasound-guided thrombolytic injection in native hemodialysis fistulas is a rapid, practical, repeatabletreatment method that is received on an outpatient basis with low risk of bleeding, and prevents unnecessary endovascular interventionsor surgical operations.

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