Savader S J, Haikal L C, Ehrman K O, Porter D J, Oteham A C
Department of Radiology, Methodist Hospital, Indianapolis, IN 46202, USA.
J Vasc Interv Radiol. 2000 Oct;11(9):1131-6. doi: 10.1016/s1051-0443(07)61353-0.
To prospectively evaluate the efficacy of a low-dose, 3-hour recombinant tissue plasminogen activator (rt-PA) infusion for the treatment of hemodialysis catheter (HDC)-associated fibrin sheaths.
Seventeen patients with end-stage renal disease (female, n = 11; male, n = 6), who were undergoing catheter-directed hemodialysis, were evaluated for 28 episodes of HDC dysfunction. This patient group ranged in age from 25 to 92 years (mean, 57 years). Radiographic contrast and/or clinical evaluation were consistent with the presence of a fibrin sheath on either the arterial and/or venous port in all cases. Patients subsequently underwent a thrombolytic infusion consisting of 2.5 mg rt-PA in 50 mL normal saline at a rate of 17 mL/h (3-hour infusion) per port. All infusions were performed in the interventional radiology recovery room, on an outpatient basis. Patients were followed-up prospectively for technical success, complications, catheter patency, and long-term outcome.
The immediate technical success rate, defined as return of manual aspiration and infusion capabilities to both ports, was 100%. No potential patients required exclusion from thrombolytic therapy secondary to contraindications, and no procedure-related complications occurred. The arithmetic mean and median catheter patency at the end of the study was 41 and 25 days, respectively (range, 1-116 days). A Kaplan-Meier survival analysis yielded a 30-, 60-, and 90-day probability of patency of 0.67, 0.61, and 0.51, respectively. At the end of the study period, all 17 patients remained on catheter-directed hemodialysis and 13 (76%) were utilizing the same catheter present at the time of entrance into the study.
Thrombolytic therapy utilizing a 2.5-mg rt-PA infusion through each port during a 3-hour period would appear to be a safe, efficient method for treating HDC-associated fibrin sheaths. Three-month patency rates are comparable to those reported for other methods of restoring function to HDC catheters, including new catheter placement, catheter exchange over a guide wire, thrombolytic infusions with urokinase, and percutaneous fibrin sheath stripping.
前瞻性评估低剂量、3小时重组组织型纤溶酶原激活剂（rt-PA）输注治疗血液透析导管（HDC）相关纤维蛋白鞘的疗效。
对17例接受导管导向血液透析的终末期肾病患者（女性11例，男性6例）进行了28次HDC功能障碍评估。该患者组年龄在25至92岁之间（平均57岁）。所有病例的影像学造影和/或临床评估均显示动脉和/或静脉端口存在纤维蛋白鞘。患者随后接受溶栓输注，每个端口以17 mL/h的速率（3小时输注）在50 mL生理盐水中注入2.5 mg rt-PA。所有输注均在门诊基础上于介入放射学恢复室进行。对患者进行前瞻性随访，观察技术成功率、并发症、导管通畅情况和长期预后。
即时技术成功率，即两个端口手动抽吸和输注功能均恢复，为100%。没有潜在患者因禁忌症而被排除在溶栓治疗之外，也没有发生与操作相关的并发症。研究结束时导管通畅的算术平均值和中位数分别为41天和25天（范围1-116天）。Kaplan-Meier生存分析得出30天、60天和90天的通畅概率分别为0.67、0.61和0.51。在研究期结束时，所有17例患者仍接受导管导向血液透析，13例（76%）使用研究开始时的同一根导管。
在3小时内通过每个端口输注2.5 mg rt-PA进行溶栓治疗似乎是治疗HDC相关纤维蛋白鞘的一种安全、有效的方法。三个月的通畅率与其他恢复HDC导管功能的方法（包括放置新导管、导丝引导下更换导管、尿激酶溶栓输注和经皮纤维蛋白鞘剥离）所报告的通畅率相当。
