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Transcatheter treatment of thrombosed hemodialysis access grafts
1Department of Radiology, University of California, San Diego Medical Center 92103-8756, USA.
Insights
Transcatheter techniques offer effective management for dialysis graft thrombosis and stenosis. This review covers thrombolytic methods, complications, and compares percutaneous approaches with surgery for graft revision.
Area of Science:
- Interventional Radiology
- Vascular Surgery
- Nephrology
Background:
- Dialysis graft thrombosis is a common complication in long-term hemodialysis patients.
- Access graft failure significantly impacts patient treatment and quality of life.
Purpose of the Study:
- To review current transcatheter techniques for managing failed dialysis grafts.
- To compare the efficacy and safety of various percutaneous methods.
Main Methods:
- Review of pharmacologic, pharmacomechanical, and mechanical thrombolytic techniques.
- Discussion of methods for treating underlying graft stenosis.
- Analysis of complications and comparison with surgical revision.
Main Results:
- Transcatheter interventions are increasingly used for primary management of failed grafts.
- Percutaneous techniques offer alternatives to traditional surgical revision.
- Evolving methods for preventing graft thrombosis are being developed.
Conclusions:
- Transcatheter techniques provide viable options for dialysis graft thrombosis and stenosis.
- Comparative analysis aids in selecting optimal treatment strategies.
- Ongoing research focuses on preventing future graft complications.
Abstract:
Thrombosis of access grafts is a frequent problem for patients being treated with long-term hemodialysis. Transcatheter techniques have recently been used in the primary management of failed dialysis grafts. This article reviews current methods for transcatheter treatment. Several thrombolytic techniques are discussed, including pharmacologic, pharmacomechanical, and mechanical methods. Methods for treatment of underlying graft stenosis are considered. Complications associated with these procedures are reviewed. The percutaneous techniques are compared among themselves and with standard surgical procedures for graft revision. Finally, several evolving methods for prevention of dialysis graft thrombosis are considered.