Failed hemodialysis shunts. One year of experience with aggressive treatment

Thirty-three failed hemodialysis access shunts in 26 patients were treated by streptokinase declotting and/or transluminal angioplasty over a period of one year. Seventeen (52%) were restored to function without surgical intervention; 7 (21%) had restoration of flow but required surgical correction of an underlying problem such as a pseudoaneurysm or vascular stenosis which resisted angioplasty; and 9 (27%) showed no improvement. The authors discuss their technique as well as causes of shunt failure, those lesions likely to be improved by declotting and/or angioplasty, and reasons for treatment failure and recurrent thrombosis.