急性シャント閉塞に対し,パルススプレー法による血栓溶解が有効であった1例

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  • Pulsed-spray pharmacomechanical thrombolysis in the treatment of an acutely thrombosed hemodialysis fistula.

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In order to achieve successful hemodialysis treatment, the maintenance of patent vascular access capable of sufficient blood flow is essential. In the case of blood-access failure an interventional technique such as percutaneous transluminal angioplasty is increasingly applied. We report a thrombosed E-PTFE A-V fistula treated by pulse-spray pharmacomechanical thrombolysis (PSPMT).<br>The patient is a 74-year-old man with chronic renal failure secondary to chronic glomerulonephritis, who had been undergoing hemodialysis for five years. He had been implanted E-PTFE-graft fistula between the left brachial artery and vein, and the left subclavian vein and superior vena cava. He was admitted with acute occlusion of the hemodialysis access. After angiography, we tried to lyse the thrombosis in the graft with PSPMT and a concomitant administration of Urokinase of 600, 000 units. About 1 hour after the treatment recanalization was successfully achieved.<br>The increasing number of elderly patients and diabetic patients is a recent worldwide trend, and access failure is frequently encountered. In these patients PSPMT is promising because of its safety and effectiveness.

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