USG-guided needle-directed pulse-spray pharmaco-mechanical thrombolysis of hemodialysis grafts/fistula: A novel technique.

The incidence of end-stage renal disease is significantly increasing and most patients who require renal transplantation are undergoing hemodialysis through tunneled/non-tunneled dialysis catheters and arteriovenous fistulas. The greatest disadvantage of the hemodialysis access is the limited durability of the arteriovenous fistulas and grafts, which, on average, remain patent for <3 years, but are the lifeline for hemodialysis patients. Catheter-directed interventions are successful in re-establishing flow in more than 80% of thrombosed hemodialysis fistulas and have become the treatment of choice for failing or thrombosed accesses.