Pulse Thrombolysis of Thrombosed Arterio-Venous Access Using Different Doses of Recombinant Tissue Plasminogen Activator.

Background: Thrombosis of arterio-venous access (AVA) is a common complication. Pulse thrombolysis for AVAfollowed by angioplasty yields high technical success rates, however, there is no consensus about thrombolyticagent or dose to be used.Pathients and methods: All patients who underwent AVA thrombolysis between July 2022 and June 2023were included. The primary outcome was primary patency. Secondary outcomes were assisted primary patency,mortality and procedure related complications. Patients were divided randomly into two equal groups. GroupI received 6mg of rt-PA for pulse thrombolysis while Group II received 10mg. All patients had angioplasty ofstenosed segments following thrombolysis.Results: Thirty-two patients underwent AVA thrombolysis during the study period with a mean follow-up periodof 32.13 weeks +/- 6.84 SD (30.44 weeks in Group I and 33.81 in Group II).After six weeks the primary patency clinically in Group I was 81.25% while it was 93.75% in Group II -P value0.29- while after six months it was 50% in Group I and 81.25% in Group II –P value 0.063.Assisted primary patency in Group I after six months was 56.25% while it was significantly higher in Group II87.5% –P value 0.05.Conclusions: Pulse thrombolysis using rt-PA has a high technical success rate. Using higher dose of rt-PA yieldhigher rate of primary patency but significantly higher in assisted primary patency after six months. Using thehigher dose of thrombolytic agent was not associated with higher mortality or procedure related complicationduring the study follow up period.