To describe and evaluate percutaneous treatment methods of complications occurring
during recanalization of thrombosed hemodialysis access grafts.
A retrospective review of 579 thrombosed hemodialysis access grafts revealed 48 complications
occurring during urokinase thrombolysis (512) or mechanical thrombectomy (67). These
include 12 venous or venous anastomotic ruptures not controlled by balloon tamponade,
eight arterial emboli, 12 graft extravasations, seven small hematomas, four intragraft
pseudointimal 'dissections', two incidents of pulmonary edema, one episode of intestinal
angina, one procedural death, and one distant hematoma.
Twelve cases of post angioplasty ruptures were treated with uncovered stents of which
10 resulted in graft salvage allowing successful hemodialysis. All arterial emboli
were retrieved by Fogarty or embolectomy balloons. The 10/12 graft extravasations
were successfully treated by digital compression while the procedure was completed
and the graft flow was restored. Dissections were treated with prolonged Percutaneous
Trasluminal Angioplasty (PTA) balloon inflation. Overall technical success was 39/48
(81%). Kaplan-Meier Primary and secondary patency rates were 72 and 78% at 30, 62
and 73% at 90 and 36 and 67% at 180 days, respectively. Secondary patency rates remained
over 50% at 1 year. There were no additional complications caused by these maneuvers.
The majority of complications occurring during percutaneous thrombolysis/thrombectomy
of thrombosed access grafts, can be treated at the same sitting allowing completion
of the recanalization procedure and usage of the same access for hemodialysis.