Thrombolysis for the treatment of thrombosed hemodialysis access grafts

Jacob Cynamon, Christopher E. Pierpont

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations


Maintaining the patency of hemodialysis access grafts remains problematic. It is best to recognize the failing graft prior to its thrombosis by noting an increase in recirculation, decreased flow (as measured by a Transonics device), changes in Doppler ultrasound flndings, elevation of venous pressures, or swelling of the arm. If a failing graft is suspected, an angiogram should be performed to evaluate the graft. If a problem is identified it should be corrected. If it is a graft thrombosis, it can be opened using percutaneous techniques. Percutaneous declotting has been evolving since its introduction in the early 1980s. At first, a low-dose thrombolytic infusion through a single catheter was used. Crossing catheters with a higher-dose infusion was then introduced. Finally, pharmacomechanical thrombolysis, which used crossing catheters and a pulse-spray technique, became popular. Several mechanical devices have proven to be efficacious as well. In 1997, we described the "lyse-and-wait" technique. We believe "lyse and wait" to be a simpler and quicker technique, and its initial success has been similar to that for the previously described techniques. After the graft is successfully declotted, the arterial plug must be mobilized and the stenotic lesion must be addressed either by angioplasty, stent placement, surgery, or any combination of these interventions.

Original languageEnglish (US)
Pages (from-to)S84-S91
JournalReviews in Cardiovascular Medicine
Issue numberSUPPL. 2
StatePublished - Jan 1 2002


  • Hemodialysis access grafts
  • Lyse-and-wait
  • Percutaneous
  • Pharmacomechanical thrombolysis
  • Pulse-spray technique
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Thrombolysis for the treatment of thrombosed hemodialysis access grafts'. Together they form a unique fingerprint.

Cite this