Thrombosed dialysis access grafts: Percutaneous mechanical declotting without urokinase

PURPOSE: To evaluate percutaneous declotting of dialysis access grafts with available catheters without urokinase. MATERIALS AND METHODS: Thirty- four clotted grafts were treated in 24 patients. Clot was macerated and pushed into the central circulation with balloon catheters. RESULTS: Successful mechanical declotting was performed in all but two patients (94%). The procedure was abandoned after successful declotting in four patients with poor venous outflow, resulting in a 24-hour success rate of 82%. Mean total procedure time was 116 minutes. Eight grafts clotted within 1 week. Using successful dialysis beyond 1 week as the measure of clinical success, the authors report a 59% clinical success rate with mean primary patency of 126 days (range, 16-322 days). Two complications, both emboli to the brachial artery, were successfully treated with urokinase. No symptomatic pulmonary emboli occurred. CONCLUSION: Mechanical thrombolysis of clotted grafts with currently available catheters yields results similar to those reported with mechanical devices and urokinase. The procedure is relatively inexpensive, safe, and well tolerated.