Faculty Collaboration Database

Ventilation-perfusion scintigraphic evaluation of pulmonary clot burden after percutaneous thrombolysis of clotted hemodialysis access grafts. Am J Kidney Dis 1999 Aug;34(2):207-11

Date

08/04/1999

Pubmed ID

10430963

DOI

10.1016/s0272-6386(99)70344-6

Scopus ID

2-s2.0-0032773609 (requires institutional sign-in at Scopus site)   38 Citations

Abstract

The objective of this study is to determine, by using rigorous methods, if pulmonary perfusion defects were detectable by ventilation-perfusion scintigraphy after percutaneous thrombolysis of clotted hemodialysis access grafts. Thirteen patients were studied. Four patients underwent pharmacomechanical thrombolysis with urokinase and the remainder had mechanical thrombolysis alone. Pre- and postthrombolysis scintigraphic studies were performed on all patients. Perfusion defects were described as vascular (well-defined borders confined to segmental boundaries) or nonvascular. Vascular defects were graded by severity (0 to 3) and area (0 to 3) for each involved segment. Nonvascular defects were graded by severity (0 to 1) and area (0 to 1). Two experienced readers evaluated the scans blinded to each other's results and all other clinical data, including thrombolysis outcomes. Twelve patients did not have any significant worsening of their perfusion defect scores postthrombolysis. In only one patient did a study show a new nonvascular perfusion defect with a matching ventilation abnormality. The defect was believed to be caused by mucus plugging. The patient had no evidence of pulmonary embolism. Our study suggests emboli that resulted from the pharmacomechanical or mechanical thrombolysis procedure were either small, underwent lysis before impacting the lung, or were below the limit of detection of ventilation-perfusion scintigraphy.

Author List

Petronis JD, Regan F, Briefel G, Simpson PM, Hess JM, Contoreggi CS

Author

Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Angioplasty, Balloon
Arteriovenous Shunt, Surgical
Female
Graft Occlusion, Vascular
Humans
Lung
Male
Middle Aged
Pulmonary Embolism
Radiography
Radionuclide Imaging
Radiopharmaceuticals
Renal Dialysis
Technetium Tc 99m Aggregated Albumin
Thrombolytic Therapy
Urokinase-Type Plasminogen Activator
Ventilation-Perfusion Ratio
Xenon Radioisotopes