Time-extended local rtPA infiltration for acutely thrombosed hemodialysis fistulas

Journal article

Publication Details

Author(s): Regus S, Lang W, Heinz M, Rother U, Meyer A, Almási-Sperling V, Uder M, Schmid A
Journal: Hemodialysis International
Publication year: 2018
Volume: 22
Journal issue: 1
Pages range: 31-36
ISSN: 1492-7535


This study describes results of a modified local thrombolysis technique for acutely thrombosed hemodialysis (HD) arteriovenous fistulas (AVF), which is characterized by prolonged recombinant tissue plasminogen activator (rtPA) local exposure times. Contrary to the standard lyse- and- wait (L&W) technique with local reaction times of 20-40 minutes, the modified protocol allows timing of challenging angioplasty maneuvers to the next regular working day.From February 2009 to April 2014, 84 patients on HD presented with 152 acutely thrombosed AVF. They proceeded to local thrombolysis including a single shot infiltration of rtPA, local reaction time up to 40 hours and finally percutaneous stenosis angioplasty. Success rates, major adverse events and need for temporary catheter placements (TCP) were retrospectively analyzed.The local thrombolysis time after single shot infiltration was 18.6 ± 6.2 (range 2-40) hours. Mean rtPA- dosage was 2.7 mg ± 1.2. The overall success rate was 89.5% and the major complication rate was 3.3%, whereas TCP was necessary in 12.5%. The PP/SP at 1, 3, 6, 12, 18, and 24 month were 86% ± 3%/95% ± 2%, 68% ± 4%/92% ± 2%, 43% ± 4%/90% ± 2%, 28% ± 4%/82% ± 3%, 12% ± 3%/82% ± 3%, 7% ± 2%/63% ± 4%, respectively.The modified L&W technique with prolonged local rtPA reaction times is a safe and effective declotting procedure. The need for TCP was not increased and therefore comparable to the standard technique.

FAU Authors / FAU Editors

Almási-Sperling, Veronika
Medizinische Fakultät
Lang, Werner apl. Prof. Dr.
Gefäßchirurgische Abteilung
Regus, Susanne PD Dr.
Gefäßchirurgische Abteilung
Uder, Michael Prof. Dr.
Lehrstuhl für Diagnostische Radiologie

How to cite

Regus, S., Lang, W., Heinz, M., Rother, U., Meyer, A., Almási-Sperling, V.,... Schmid, A. (2018). Time-extended local rtPA infiltration for acutely thrombosed hemodialysis fistulas. Hemodialysis International, 22(1), 31-36. https://dx.doi.org/10.1111/hdi.12528

Regus, Susanne, et al. "Time-extended local rtPA infiltration for acutely thrombosed hemodialysis fistulas." Hemodialysis International 22.1 (2018): 31-36.


Last updated on 2018-05-10 at 02:26