Thrombosed synthetic hemodialysis access fistulas: failure of fibrinolytic therapy.

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Abstract
Seven episodes of acute thrombosis occurring in 5 patients with polytetrafluoroethylene dialysis fistulas were treated with local infusions of low-dose streptokinase. Bleeding from previous dialysis puncture sites necessitated stopping the infusion in 6 out of 7 patients, although in 1 of these 6, the graft reopened. The 7th patient had never been dialyzed through the graft and thrombolysis was achieved without incident. Surgery was avoided in only 1 patient. In these patients the risks of fibrinolytic therapy outweigh the benefits. Surgical thrombectomy, coupled with intraoperative angiography and possible angioplasty, is the preferred method of treating these patients. Venography prior to the creaton of the fistula helps the surgeon avoid diseased vessels and may avert early failure of the fistula.

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