Klinik Araştırma
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Outpatient use of tPA to recanalize thrombosed native fistulas a case series and discussion of literature

Yıl 2022, Cilt 3, Sayı 2, 120 - 125, 31.05.2022

Öz

Background: The present study aims to evaluate the effectiveness of ultrasound-guided percutaneous alteplase (t-PA) injection for the treatment of long segment ( ≥14cm) thrombi in the efferent veins of native arteriovenous fistulas in hemodialysis patients.

Methods: A total of 9 patients who underwent t-PA application under ultrasound guidance in the interventional radiology clinic between 2019 and 2021 were included in the study. During the intervention, information such as thrombosed segment length, t-PA dose, number of sessions, presence of aneurysmal segment, bleeding after the intervention and the need for percutaneous transluminal angioplasty (PTA) were recorded. Restoring the flow in the fistula was considered the successful outcome. All statistical evaluations were performed with the IBM SPSS Statistics 21 software (version 21.0; SPSS Inc, Chicago, Illinois) for Windows.

Results: Mean age of the patients was 48.7±14 years, the fistula age was 28.7±11 months, the thrombosis age was 3.5±2 days, and the thrombosed segment length was 17.7±2.9 cm. Post-intervention bleeding that did not require treatment was encountered in 2 patients, and stenosis in the proximal fistula was encountered in 6 patients. PTA was applied to 7 patients after t-PA. After the interventions, effective flow was provided in all patients.

Conclusion: Ultrasound-guided percutaneous t-PA injection should be considered as an effective intervention which is less invasive, can be performed as an outpatient intervention and has fewer complications, even if the thrombi segments are long (>10 cm). This technique avoids the potential endothelial damage and saves the cost of the mechanical devices.

Kaynakça

  • 1. Agarwal AK, Haddad N, Boubes K. Avoiding problems in tunneled dialysis catheter placement. Semin Dial 2019; 32(6):535-40.
  • 2. Murea M, Geary RL, Davis RP, Moossavi S. Vascular access for hemodialysis: A perpetual challenge. Semin Dial 2019; 32(6):527-34.
  • 3. Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. Complications of the Arteriovenous Fistula: A Systematic Review. J Am Soc Nephrol 2017; 28(6):1839-50.
  • 4. Coleman CI, Tuttle LA, Teevan C, Baker WL, White CM, Reinhart KM. Antiplatelet agents for the prevention of arteriovenous fistula and graft thrombosis: a meta analysis. Int J Clin Pract 2010; 64(9): 1239-44.
  • 5. Swedberg SH, Brown BG, Sigley R, Wight TN, Gordon D, Nicholls SC. Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment. Circulation 1989; 80(6): 1726-36.
  • 6. Dougherty MJ, Calligaro KD, Schindler N, Raviola CA, Ntoso A. Endovascular versus surgical treatment for thrombosed hemodialysis grafts: A prospective, randomized study. J Vasc Surg 1999; 30(6):1016-23.
  • 7. Marston WA, Criado E, Jaques PF, Mauro MA, Burnham SJ, Keagy BA.Prospective randomized comparison of surgical versus endovascularmanagement of thrombosed dialysis access grafts. J Vasc Surg 1997; 26(3):373-80; discussion 80-1.
  • 8. Gravanis I, Tsirka SE. Tissue-type plasminogen activator as a therapeutic target in stroke. Expert Opin Ther Targets 2008; 12(2):159-70.
  • 9. Heiferman DM, Li DD, Pecoraro NC, Smolenski AM, Tsimpas A, Ashley WW Jr. Intra-Arterial Alteplase Thrombolysis during Mechanical Thrombectomy for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26(12):3004-8.
  • 10. Islam MS. Thrombolytic Therapy by Tissue Plasminogen Activator for Pulmonary Embolism. Adv Exp Med Biol 2017; 906:67-74.
  • 11. Sharifi M, Bay C, Nowroozi S, Bentz S, Valeros G, Memari S. Catheterdirected thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis. Cardiovasc Intervent Radiol 2013 36(6):1586-90.
  • 12. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta J et al. American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.
  • 13. Durmaz H, Birgi E. A promising method for the salvage of thrombosed native hemodialysis fistulas: percutaneous ultrasoundguided thrombolytic injection. Turk J Med Sci 2019; 49(4):1179-84.
  • 14. Schon D, Mischler R. Salvage of occluded autologous arteriovenous fistulae. Am J Kidney Dis. 2000; 36(4):804-10.
  • 15. Falk A, Mitty H, Guller J, Teodorescu V, Uribarri J, Vassalotti J. Thrombolysis of clotted hemodialysis grafts with tissue-type plasminogen activator. J Vasc Interv Radiol 2001; 12(3):305-11.
  • 16. Vogel PM, Bansal V, Marshall MW. Thrombosed hemodialysis grafts: lyse and wait with tissue plasminogen activator or urokinase compared to mechanical thrombolysis with the Arrow- Trerotola Percutaneous Thrombolytic Device. J Vasc Interv Radiol 2001;12(10):1157-65.
  • 17. Inston N, Al Shakarchi J, Khawaja A, Jones R. Maintaining Patency of Vascular Access for Haemodialysis. Cardiovasc Eng Technol 2017; 8(3):240-3.
  • 18. Koraen-Smith L, Krasun M, Bottai M, Hedin U, Wahlgren CM, Gillgren P. Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion. J Vasc Access. 2018;19(6):535-41.
  • 19. Tseke P, Kalyveza E, Politis E, Giapraka N, Andriopoulos C, Balitsari A et.al. Thrombolysis with alteplase: a non-invasive treatment for occluded arteriovenous fistulas and grafts. Artif Organs. 2011 Jan;35(1):58-62.
  • 20. Aydin E, Bademci MS, Kocaaslan C. Comparison of pharmacomechanical and surgical interventions for thrombosed native arteriovenous fistulas. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28(4):609-14.
  • 21. Koraen-Smith L, Krasun M, Bottai M, Hedin U, Wahlgren CM, Gillgren P. Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion. J Vasc Access. 2018;19(6):535-541.
  • 22. Hilleman D, Campbell J. Efficacy, safety, and cost of thrombolytic agents for the management of dysfunctional hemodialysis catheters: a systematic review. Pharmacotherapy 2011; 31(10):1031-40.
  • 23. Wan Z, Xiang R, Wang H, Zhong Q, Tu B. Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas. Exp Ther Med 2019;17(5):4279-84.
  • 24. Xie H, Kim K, Aglyamov SR, Emelianov SE, Xunchang C, O’Donnell M et al. Staging deep venous thrombosis using ultrasound elasticity imaging: animal model. Ultrasound Med Biol 2004;30:1385-96.
  • 25. Fineschi V, Turillazzi E, Neri M, Pomara C, Riezzo I. Histological age determination of venous thrombosis: a neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int. 2009;186(1-3):22-8.
  • 26. Stanford SN, Sabra A, D’Silva L, Lawrence M, Morris RHK, Storton S. The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study. BMC Neurol 2015;15:35.
  • 27. Oklu R, Wicky S. Catheter-directed thrombolysis of deep venous thrombosis. Semin Thromb Hemost 2013;39:446-51.
  • 28. Goktay AY, Senturk C. Endovascular Treatment of Thrombosis and Embolism. Adv Exp Med Biol 2017;906:195-213.
  • 29. Andriani M, Drago G, Bernardi AM, Da Porto A, De Luca M, Riegler P et al. Recombinant tissue plasminogen activator (rt-PA) as firstline therapy for declotting of haemodialysis access. Nephrol Dial Transplant. 1995;10(9):1714-9.
  • 30. Regus S, Lang W, Heinz M, Uder M, Schmid A. Benefits of Long Versus Short Thrombolysis Times for Acutely Thrombosed Hemodialysis Native Fistulas. Vasc Endovascular Surg 2017; 51(5): 233-9.
  • 31. Chang R, Horne MK, 3rd, Shawker TH et al. Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis. J Vasc Interv Radiol 2011;22(8): 1107-16.

Yıl 2022, Cilt 3, Sayı 2, 120 - 125, 31.05.2022

Öz

Kaynakça

  • 1. Agarwal AK, Haddad N, Boubes K. Avoiding problems in tunneled dialysis catheter placement. Semin Dial 2019; 32(6):535-40.
  • 2. Murea M, Geary RL, Davis RP, Moossavi S. Vascular access for hemodialysis: A perpetual challenge. Semin Dial 2019; 32(6):527-34.
  • 3. Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. Complications of the Arteriovenous Fistula: A Systematic Review. J Am Soc Nephrol 2017; 28(6):1839-50.
  • 4. Coleman CI, Tuttle LA, Teevan C, Baker WL, White CM, Reinhart KM. Antiplatelet agents for the prevention of arteriovenous fistula and graft thrombosis: a meta analysis. Int J Clin Pract 2010; 64(9): 1239-44.
  • 5. Swedberg SH, Brown BG, Sigley R, Wight TN, Gordon D, Nicholls SC. Intimal fibromuscular hyperplasia at the venous anastomosis of PTFE grafts in hemodialysis patients. Clinical, immunocytochemical, light and electron microscopic assessment. Circulation 1989; 80(6): 1726-36.
  • 6. Dougherty MJ, Calligaro KD, Schindler N, Raviola CA, Ntoso A. Endovascular versus surgical treatment for thrombosed hemodialysis grafts: A prospective, randomized study. J Vasc Surg 1999; 30(6):1016-23.
  • 7. Marston WA, Criado E, Jaques PF, Mauro MA, Burnham SJ, Keagy BA.Prospective randomized comparison of surgical versus endovascularmanagement of thrombosed dialysis access grafts. J Vasc Surg 1997; 26(3):373-80; discussion 80-1.
  • 8. Gravanis I, Tsirka SE. Tissue-type plasminogen activator as a therapeutic target in stroke. Expert Opin Ther Targets 2008; 12(2):159-70.
  • 9. Heiferman DM, Li DD, Pecoraro NC, Smolenski AM, Tsimpas A, Ashley WW Jr. Intra-Arterial Alteplase Thrombolysis during Mechanical Thrombectomy for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2017; 26(12):3004-8.
  • 10. Islam MS. Thrombolytic Therapy by Tissue Plasminogen Activator for Pulmonary Embolism. Adv Exp Med Biol 2017; 906:67-74.
  • 11. Sharifi M, Bay C, Nowroozi S, Bentz S, Valeros G, Memari S. Catheterdirected thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis. Cardiovasc Intervent Radiol 2013 36(6):1586-90.
  • 12. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta J et al. American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.
  • 13. Durmaz H, Birgi E. A promising method for the salvage of thrombosed native hemodialysis fistulas: percutaneous ultrasoundguided thrombolytic injection. Turk J Med Sci 2019; 49(4):1179-84.
  • 14. Schon D, Mischler R. Salvage of occluded autologous arteriovenous fistulae. Am J Kidney Dis. 2000; 36(4):804-10.
  • 15. Falk A, Mitty H, Guller J, Teodorescu V, Uribarri J, Vassalotti J. Thrombolysis of clotted hemodialysis grafts with tissue-type plasminogen activator. J Vasc Interv Radiol 2001; 12(3):305-11.
  • 16. Vogel PM, Bansal V, Marshall MW. Thrombosed hemodialysis grafts: lyse and wait with tissue plasminogen activator or urokinase compared to mechanical thrombolysis with the Arrow- Trerotola Percutaneous Thrombolytic Device. J Vasc Interv Radiol 2001;12(10):1157-65.
  • 17. Inston N, Al Shakarchi J, Khawaja A, Jones R. Maintaining Patency of Vascular Access for Haemodialysis. Cardiovasc Eng Technol 2017; 8(3):240-3.
  • 18. Koraen-Smith L, Krasun M, Bottai M, Hedin U, Wahlgren CM, Gillgren P. Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion. J Vasc Access. 2018;19(6):535-41.
  • 19. Tseke P, Kalyveza E, Politis E, Giapraka N, Andriopoulos C, Balitsari A et.al. Thrombolysis with alteplase: a non-invasive treatment for occluded arteriovenous fistulas and grafts. Artif Organs. 2011 Jan;35(1):58-62.
  • 20. Aydin E, Bademci MS, Kocaaslan C. Comparison of pharmacomechanical and surgical interventions for thrombosed native arteriovenous fistulas. Turk Gogus Kalp Damar Cerrahisi Derg 2020; 28(4):609-14.
  • 21. Koraen-Smith L, Krasun M, Bottai M, Hedin U, Wahlgren CM, Gillgren P. Haemodialysis access thrombosis: Outcomes after surgical thrombectomy versus catheter-directed thrombolytic infusion. J Vasc Access. 2018;19(6):535-541.
  • 22. Hilleman D, Campbell J. Efficacy, safety, and cost of thrombolytic agents for the management of dysfunctional hemodialysis catheters: a systematic review. Pharmacotherapy 2011; 31(10):1031-40.
  • 23. Wan Z, Xiang R, Wang H, Zhong Q, Tu B. Comparative efficacy and safety of local and peripheral venous thrombolytic therapy with urokinase for thrombosed hemodialysis arteriovenous fistulas. Exp Ther Med 2019;17(5):4279-84.
  • 24. Xie H, Kim K, Aglyamov SR, Emelianov SE, Xunchang C, O’Donnell M et al. Staging deep venous thrombosis using ultrasound elasticity imaging: animal model. Ultrasound Med Biol 2004;30:1385-96.
  • 25. Fineschi V, Turillazzi E, Neri M, Pomara C, Riezzo I. Histological age determination of venous thrombosis: a neglected forensic task in fatal pulmonary thrombo-embolism. Forensic Sci Int. 2009;186(1-3):22-8.
  • 26. Stanford SN, Sabra A, D’Silva L, Lawrence M, Morris RHK, Storton S. The changes in clot microstructure in patients with ischaemic stroke and the effects of therapeutic intervention: a prospective observational study. BMC Neurol 2015;15:35.
  • 27. Oklu R, Wicky S. Catheter-directed thrombolysis of deep venous thrombosis. Semin Thromb Hemost 2013;39:446-51.
  • 28. Goktay AY, Senturk C. Endovascular Treatment of Thrombosis and Embolism. Adv Exp Med Biol 2017;906:195-213.
  • 29. Andriani M, Drago G, Bernardi AM, Da Porto A, De Luca M, Riegler P et al. Recombinant tissue plasminogen activator (rt-PA) as firstline therapy for declotting of haemodialysis access. Nephrol Dial Transplant. 1995;10(9):1714-9.
  • 30. Regus S, Lang W, Heinz M, Uder M, Schmid A. Benefits of Long Versus Short Thrombolysis Times for Acutely Thrombosed Hemodialysis Native Fistulas. Vasc Endovascular Surg 2017; 51(5): 233-9.
  • 31. Chang R, Horne MK, 3rd, Shawker TH et al. Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis. J Vasc Interv Radiol 2011;22(8): 1107-16.

Ayrıntılar

Birincil Dil İngilizce
Konular Tıp
Bölüm ORIGINAL ARTICLE
Yazarlar

Isil YİLDİZ (Sorumlu Yazar)
Acibadem University Atakent Hospital, Department of Radiology, İstanbul, Turkey
0000-0002-2254-977X
Türkiye


Demet GÜNDÜZ
Süleyman Demirel University Faculty of Medicine, Department of Radiology, Isparta, Turkey
0000-0003-4358-984X
Türkiye


Can ÇALIŞKAN
Acibadem University Atakent Hospital, Department of Radiology, İstanbul, Turkey
0000-0001-8291-0574
Türkiye

Yayımlanma Tarihi 31 Mayıs 2022
Başvuru Tarihi 16 Şubat 2022
Kabul Tarihi 19 Mayıs 2022
Yayınlandığı Sayı Yıl 2022, Cilt 3, Sayı 2

Kaynak Göster

APA Yildiz, I. , Gündüz, D. & Çalışkan, C. (2022). Outpatient use of tPA to recanalize thrombosed native fistulas a case series and discussion of literature . Archives of Current Medical Research , 3 (2) , 120-125 . Retrieved from https://dergipark.org.tr/tr/pub/acmr/issue/70106/1074152

Archives of Current Medical Research (ACMR) provides instant open access to all content, bearing in mind the fact that presenting research

free to the public supports a greater global exchange of knowledge.

http://www.acmronline.org/