الفهرس 
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Abstract
S
UMMAR Y
aintaining vascular access for the patient undergoing hemodialysis (HD) is a major source of hospitalization, patient morbidity, and physician frustration. Percutaneous methods of treating thrombosed arteriovenous accesses (AVAs) have evolved to become an effective alternative to surgical thrombectomy. In cases of recently thrombosed AVA, minimally invasive thrombolysis, and adjunctive angioplasty of the myointimal hyperplasia lesion(s) is considered as a reasonable management strategy to dissolve the recently formed thrombus to restore patency & function of AVA.
Our study aims to compare the efficacy and safety of using two different doses (6ml vs 10ml) of recombinant tissue plasminogen activator (rTPA) for pulse-spray thrombolysis of thrombosed hemodialysis access.
We conducted a Prospective randomized controlled clinical study at Ain -shams university hospitals during the period from July 2022 to December 2022 on 32 patients with recently thrombosed arteriovenous fistulae and grafts recruited for ultrasound guided Pulse-Spray Thrombolysis of the AVAs followed by angiography +/- balloon dilatation of the stenosed lesion according to the finding of the angiogram.
Patients were included in the study if their AVAs were mature and the duration of AVA thrombosis didn‟t exceed two weeks, their age ranged between eighteen to sixty -five years
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Summary
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old, had no contraindications for rTPA, and signed the informed consent.
We have excluded patients who had any signs of AVA infection, and Patients with contraindication for thrombolysis and/or anticoagulation were excluded too.
Patients had been divided randomly into two equal groups by closed envelops method group I received 6ml rTPA, group II received 10ml rTPA, and followed up for six weeks post procedure.
The immediate post-procedure technical success was 100% in both study groups. Clinical success was achieved in 81.25% in group I, and 93.75% in group II (P-value = 0.285), The six weeks post -operative primary patency rates were 81.25% and 93.75% for group I and group II, respectively (P-value = 0.285).
No mortality cases reported, one case of group II developed diffuse upper arm hematoma which resolved completely after 8 days, and one case in group I developed small puncture site hematoma resolved after 2 days, and both cases treated with conservative measures, post- operative bleeding from puncture site occurred in two cases in group I and one case in group II, bleeding stopped after few minutes of manual compression, None of the patients had bleeding elsewhere, steal syndrome or infection.