Thrombolysis for the treatment of thrombosed hemodialysis access grafts.

Jacob Cynamon, Christopher E. Pierpont

Research output: Contribution to journalArticle

Abstract

Maintaining the patency of hemodialysis access grafts remains problematic. It is best to recognize the failing graft prior to its thrombosis by noting an increase in recirculation, decreased flow (as measured by a Transonics device), changes in Doppler ultrasound findings, elevation of venous pressures, or swelling of the arm. If a failing graft is suspected, an angiogram should be performed to evaluate the graft. If a problem is identified it should be corrected. If it is a graft thrombosis, it can be opened using percutaneous techniques. Percutaneous declotting has been evolving since its introduction in the early 1980s. At first, a low-dose thrombolytic infusion through a single catheter was used. Crossing catheters with a higher-dose infusion was then introduced. Finally, pharmacomechanical thrombolysis, which used crossing catheters and a pulse-spray technique, became popular. Several mechanical devices have proven to be efficacious as well. In 1997, we described the "lyse-and-wait" technique. We believe "lyse and wait" to be a simpler and quicker technique, and its initial success has been similar to that for the previously described techniques. After the graft is successfully declotted, the arterial plug must be mobilized and the stenotic lesion must be addressed either by angioplasty, stent placement, surgery, or any combination of these interventions.

Original languageEnglish (US)
JournalReviews in Cardiovascular Medicine
Volume3 Suppl 2
StatePublished - 2002

Fingerprint

Renal Dialysis
Thrombosis
Transplants
Catheters
Therapeutics
Doppler Ultrasonography
Equipment and Supplies
Venous Pressure
Angioplasty
Stents
Angiography
Arm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Thrombolysis for the treatment of thrombosed hemodialysis access grafts. / Cynamon, Jacob; Pierpont, Christopher E.

In: Reviews in Cardiovascular Medicine, Vol. 3 Suppl 2, 2002.

Research output: Contribution to journalArticle

@article{c63836d38022400497e2923c8446539c,
title = "Thrombolysis for the treatment of thrombosed hemodialysis access grafts.",
abstract = "Maintaining the patency of hemodialysis access grafts remains problematic. It is best to recognize the failing graft prior to its thrombosis by noting an increase in recirculation, decreased flow (as measured by a Transonics device), changes in Doppler ultrasound findings, elevation of venous pressures, or swelling of the arm. If a failing graft is suspected, an angiogram should be performed to evaluate the graft. If a problem is identified it should be corrected. If it is a graft thrombosis, it can be opened using percutaneous techniques. Percutaneous declotting has been evolving since its introduction in the early 1980s. At first, a low-dose thrombolytic infusion through a single catheter was used. Crossing catheters with a higher-dose infusion was then introduced. Finally, pharmacomechanical thrombolysis, which used crossing catheters and a pulse-spray technique, became popular. Several mechanical devices have proven to be efficacious as well. In 1997, we described the {"}lyse-and-wait{"} technique. We believe {"}lyse and wait{"} to be a simpler and quicker technique, and its initial success has been similar to that for the previously described techniques. After the graft is successfully declotted, the arterial plug must be mobilized and the stenotic lesion must be addressed either by angioplasty, stent placement, surgery, or any combination of these interventions.",
author = "Jacob Cynamon and Pierpont, {Christopher E.}",
year = "2002",
language = "English (US)",
volume = "3 Suppl 2",
journal = "Reviews in Cardiovascular Medicine",
issn = "1530-6550",
publisher = "MedReviews LLC",

}

TY - JOUR

T1 - Thrombolysis for the treatment of thrombosed hemodialysis access grafts.

AU - Cynamon, Jacob

AU - Pierpont, Christopher E.

PY - 2002

Y1 - 2002

N2 - Maintaining the patency of hemodialysis access grafts remains problematic. It is best to recognize the failing graft prior to its thrombosis by noting an increase in recirculation, decreased flow (as measured by a Transonics device), changes in Doppler ultrasound findings, elevation of venous pressures, or swelling of the arm. If a failing graft is suspected, an angiogram should be performed to evaluate the graft. If a problem is identified it should be corrected. If it is a graft thrombosis, it can be opened using percutaneous techniques. Percutaneous declotting has been evolving since its introduction in the early 1980s. At first, a low-dose thrombolytic infusion through a single catheter was used. Crossing catheters with a higher-dose infusion was then introduced. Finally, pharmacomechanical thrombolysis, which used crossing catheters and a pulse-spray technique, became popular. Several mechanical devices have proven to be efficacious as well. In 1997, we described the "lyse-and-wait" technique. We believe "lyse and wait" to be a simpler and quicker technique, and its initial success has been similar to that for the previously described techniques. After the graft is successfully declotted, the arterial plug must be mobilized and the stenotic lesion must be addressed either by angioplasty, stent placement, surgery, or any combination of these interventions.

AB - Maintaining the patency of hemodialysis access grafts remains problematic. It is best to recognize the failing graft prior to its thrombosis by noting an increase in recirculation, decreased flow (as measured by a Transonics device), changes in Doppler ultrasound findings, elevation of venous pressures, or swelling of the arm. If a failing graft is suspected, an angiogram should be performed to evaluate the graft. If a problem is identified it should be corrected. If it is a graft thrombosis, it can be opened using percutaneous techniques. Percutaneous declotting has been evolving since its introduction in the early 1980s. At first, a low-dose thrombolytic infusion through a single catheter was used. Crossing catheters with a higher-dose infusion was then introduced. Finally, pharmacomechanical thrombolysis, which used crossing catheters and a pulse-spray technique, became popular. Several mechanical devices have proven to be efficacious as well. In 1997, we described the "lyse-and-wait" technique. We believe "lyse and wait" to be a simpler and quicker technique, and its initial success has been similar to that for the previously described techniques. After the graft is successfully declotted, the arterial plug must be mobilized and the stenotic lesion must be addressed either by angioplasty, stent placement, surgery, or any combination of these interventions.

UR - http://www.scopus.com/inward/record.url?scp=0036985539&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036985539&partnerID=8YFLogxK

M3 - Article

VL - 3 Suppl 2

JO - Reviews in Cardiovascular Medicine

JF - Reviews in Cardiovascular Medicine

SN - 1530-6550

ER -