Angioplasty/thrombolytic treatment of failing and failed hemodialysis access sites: comparison with surgical treatment.

Angioplasty is a valuable alternative to surgical revision of failing hemodialysis access sites and may be the treatment of choice because no further vein is compromised during the revision and because patency rates with repeat dilatations approach or equal those of surgical revision. Thrombolysis/angioplasty is a worthy substitute for surgical thrombectomy/revision in thrombosed access sites because dialysis can be resumed immediately, without the need of placement of a temporary subclavian vein access catheter, and lysis can be performed on an outpatient basis. Long-term secondary patency also approaches that of surgical therapy. Again, future access sites are not compromised. Either with percutaneous catheter or surgical therapy, it must be recognized that repeat treatment will be necessary to maintain patency of the access site after it has thrombosed. Close follow-up of these patients to observe for signs of recurring deterioration is mandatory. Because the number of vascular access sites is limited, the preservation of each site for as long as possible is important for the long-term management of these patients.