Streptokinase and transluminal angioplasty in the treatment of acutely thrombosed hemodialysis access fistulas.

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Abstract
Streptokinase [SK] was selectively infused into 9 thrombosed hemodialysis access fistulas in 8 patients. Lysis occurred in all but 1 case. Of the 8 infusions producing lysis, 7 resulted in some clinical benefit. Three grafts functioned adequately for 2-6 mo. after SK infusion alone. A 4th patient had good function for over 11 mo. after SK treatment and transluminal angioplasty. In a 5th patient, graft function was partially restored, but a persistent arterial defect led to elective graft replacement. Moderate fibrinolysis in the 6th case was of no clinical benefit; rethrombosis developed promptly after SK was discontinued because of bleeding from a recent puncture site. In cases 7 and 8, fibrinolysis restored arterial inflow to the graft, but surgery was needed to revise partially obstructed venous outflow. Selective streptokinase infusion, with or without transluminal angioplasty and operation, is evidently often effective in the treatment of acutely thrombosed vascular access fistulas.