Management of autogenous arteriovenous (AV) fistula thrombosis part 2

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

Juxta-anastomotic stenosis most common. Photo courtesy of L. Spergel, MD.

 

Interventional trombolysis

Trombolisis can be performed mecahanically or pharmacomechanically. While, the immediate success rate is higher in grafts than autogenous arteriovenous (AV) fistula (99 vs 93% in forearm fistula), the primary patency rate of the forearm arteriovenous fistula at 1 year is much higher  . One year secondary patency rates are 80% in forearm and 50% in upper arm arteriovenous fistula., respectively. In arteriovenous fistula, the combination of a thrombolytic  agent (urokinase or tissue plasminogen activator=tPA) with balloon angioplasty resulted in  an immediate success rate of 94%. Flow restoration was achieved in 88,9% of the arteriovenous fistula.

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