Introduction:
Arteriovenous fistula (AVF) is the Achilles heel of a hemodialysis (HD) patient. Acute thrombosis of AVF can lead to significant morbidity and mortality in these patients. AVF salvage procedures that involve catheterization labs are costly. USG guided needle directed thrombolysis can be a cheap, easily accessible, radiation free treatment option for poor patients with acute AVF thrombosis.
Methods:
We present a case series of 8 cases we attempted USG guided needle directed thrombolysis from a small 100 bedded hospital in Kerala, India. The Study period was from June 2022 to June 2024. Patients were taken up for the procedure as an emergency from our casualty itself as soon as they presented to the hospital. Streptokinase was used as the thrombolytic agent as it was cheap and easily available.
Results:
In 3 out of 8 cases, we could attain on-table complete thrombolysis. Partial thrombolysis was attained in 1 patient. Mild allergic reaction was encountered in 2 patients. None had significant bleeding complications, infections or pulmonary embolism. There was no mortality. The 5 failed cases were referred to higher centers for Cath Lab directed endovascular procedures, of which only 2 AVFs could be salvaged.
Conclusions:
USG guided needle directed thrombolysis is a safe and ionizing radiation free treatment option for acute AVF thrombosis. Its 1/16th times cheaper than conventional Cath Lab directed endovascular procedure. It needs only minimum hardware which is available in most of the small hospitals.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.