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

Abstract

Background/aim: It was aimed to describe the technical aspects and outcomes of percutaneous ultrasound-guided recanalization of thrombosed hemodialysis fistulas by thrombolytic injection. Materials and methods: A retrospective review was performed on patients with thrombosed native hemodialysis fistula who were treated 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 demographic information 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 on the venous side of the anastomosis in 35.3% (n: 6). The mean dose of tissue plasminogen activator (tPA) used in all of the sessions was 8.88 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, repeatable treatment method that is received on an outpatient basis with low risk of bleeding, and prevents unnecessary endovascular interventions or surgical operations.

Placement of hemodialysis catheters with the help of the micropuncture technique in patients with central venous occlusion and limited access

“…Several methods such as native arteriovenous fistula, arteriovenous grafts and central venous catheters have been defined for hemodialysis process [12]. Central venous tunneled catheter placement in patients with end stage renal disease and with no hope to create upper limb arteriovenous fistul/arteriovenous graft or need time for fistula maturation is essential for continuous dialysis sessions [2].…”