Failed hemodialysis shunts. One year of experience with aggressive treatment.

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Abstract
Failed hemodialysis access shunts (33) in 26 patients were treated by streptokinase declotting and/or transluminal angioplasty over a period of 1 yr. Seventeen (52%) were restored to function without surgical intervention; 7 (21%) had restoration of flow but required surgical correction of an underlying problem such as a pseudoaneurysm or vascular stenosis which resisted angioplasty; and 9 (27%) showed no improvement. The technique, causes of shunt failure, those lesions likely to be improved by declotting and/or angioplasty, and reasons for treatment failure and recurrent thrombosis were discussed.