Pharmacomechanical thrombolysis with urokinase for treatment of thrombosed hemodialysis access grafts. A comparison with surgical thrombectomy.

Seventy-one consecutively occluded polytetrafluoroethylene (PTFE) grafts treated with pharmacomechanical thrombolysis were compared with 75 surgical controls. The patients undergoing thrombomechanical lysis had a comparable rate of successful declotting (91% vs. 90.7%) and no significant difference in patency at 24 and 48 hr, 1 week, and 1 and 6 months. Patients undergoing thrombolysis required less overnight hospitalization (17 vs. 82%) (P < 0.001) and their hospital stays averaged 1.03 days versus 3.43 days in the surgical thrombectomy group (P < 0.0001). Complication rates were similar in both groups. Hospital charges and physician fees were significantly lower in the thrombolysis group, with total charges averaging $6,802 versus $12,740 (P = 0.0018). These cost differences were maintained even when patients with extended stays were excluded. In conclusion, pharmacomechanical thrombolysis provides efficacy and complications comparable to surgical thrombectomy, with the benefits of a decreased rate of hospitalization, decreased total number of days of hospitalization, and significant cost savings. The authors determined that pharmacomechanical thrombolysis is the preferable first intervention for acutely occluded PTFE grafts.