Angioplasty and bolus urokinase infusion for the restoration of function in thrombosed Brescia-Cimino dialysis fistulas

PURPOSE: To evaluate the use of urokinase and angioplasty in treatment of thrombosed Brescia-Cimino fistulas, MATERIALS AND METHODS: From January 1994 to April 1997, 17 patients (10 women and seven men; age range, 17-78 years; mean 54 years) with complete thrombosis of their Brescia-Cimino fistulas were referred to our department for thrombolysis and angioplasty. Thrombosis of the fistula had occurred within 24 hours of attempted thrombolysis in 11 patients and between 24 and 72 hours in six patients. Urokinase was given as a bolus into the fistula, and heparin was administered into the central venous vasculature. Angioplasty was performed at the arterial inflow and the fistula itself. RESULTS: Procedural success was 82% (14 of 17 patients). Primary patency was 71% at 6 months and 64% at 12 months. Primary assisted patency was 93% at 6 and 12 months. Secondary patency was 100% at 6 and 12 months, One fistula thrombosed within 24 hours of the initial procedure, and a repeat procedure was successfully performed. All other fistulas have remained patent with a maximum follow-up of 40 months (average function of 16 months). Two patients have died of unrelated causes. One Wallstent was deployed for treatment of an angioplasty-induced venous rupture. CONCLUSION: Long-term function of Brescia-Cimino fistulas after thrombolysis and angioplasty is excellent with patency rates similar to those of newly placed, mature Brescia-Cimino fistulas.