Ultrasound-guided injection thrombolysis for thrombosis of permanent vascular access for hemodialysis

Objective. To develop the method for injection intraarterial thrombolysis of permanent vascular access using only ultrasound navigation and to evaluate its immediate results. Material and methods. A retrospective study included 20 patients with permanent vascular access thrombosis hospitalized at the Nizhnevartovsk District Clinical Hospital between October 2021 and September 2024. All patients underwent injection thrombolysis supplemented by ultrasound-guided angioplasty. There were 12 (60%) men and 8 (40%) women, mean age was 59.6±12.4 years. Alteplase was used. Under ultrasound control, the drug was injected into the thrombosed segment with a 23g needle via 1—2 points. Baseline dose was 5—10 mg. If necessary, repeated injections were performed (usually after 2—3 hours). Mean number of injections was 1.3±0.14 (1—2). Results. Technical efficiency (complete reduction of thrombotic masses) of injection thrombolysis was 100%, clinical efficiency (restoration of blood flow with linear and volumetric characteristics sufficient for the next hemodialysis session) — 85%. The lysis time ranged from 1 to 12 hours (mean 4.5±0.9 hours). Mean volume of thrombolytic agent was 14.3±2.4 mg. In 7 patients, complete lysis of thrombus was not accompanied by restoration of blood flow through arteriovenous fistula, and emergency ultrasound-guided balloon angioplasty was performed. In 3 cases, it was unsuccessful due to elastic return of angioplasty zones. In 13 patients with restored blood flow through the fistula, delayed balloon angioplasty was performed with 100% efficiency. No fatal cases and major hemorrhagic complications were recorded. Conclusion. The first experience of injection thrombolysis showed high immediate effectiveness and safety. This technique allows not only to restore patency of arteriovenous access, but also to eliminate the cause of occlusion within one surgical session without X-ray surgical techniques.