CardioVascular and Interventional Radiology

, Volume 24, Issue 1, pp 53–56 | Cite as

Ultrasound thrombolysis in hemodialysis access: In vitro investigation

  • Joachim Ernst Wildberger
  • Thomas Schmitz-Rode
  • Patrick Haage
  • Joachim Pfeffer
  • Alexander Ruebben
  • Rolf W. Günther
Laboratory Investigation


Purpose: To evaluate the effectiveness of ultrasound thrombolysis in occluded hemodialysis access shunts using an in vitro model.

Methods: Thrombosed hemodialysis accesses were simulated by clotted bovine blood in a flow model (silicone tubing; inner diameters 4, 6, and 9 mm). After retrograde and antegrade sheath placement (7 Fr), mechanical thrombolysis was performed using an ultrasound probe (Acolysis, Angiosonics, Morrisville, NC, USA). The tip of the device measured 2.2 mm in diameter. During sonication, the catheter was moved slowly back and forth using an over-the-wire system. Thirty complete occlusions [tubing diameters 4 mm (n=12), 6 mm (n=12). 9 mm (n=6)] were treated, initial thrombus weights were 3.5 (±0.76) g, 7.7 (±1.74) g, and 19.4 (±2.27) g for the three diameters. Maximum sonication time was 15 min for each probe.

Results: With this device, we were able to restore a continuous lumen in all 12 occluded 4∼mm silicone tubes. No wall-adherent thrombi remained after sonication for 3.5–9.6 min. In hemodialysis access models with diameters of 6 mm, thrombus fragments persisted in 25% (3/12 accesses). These were located in the medial portion of the access loop and near to the puncture sites. However, flow was re-established after 5.0–13.0 min of treatment in all settings. Mechanical dissolution of thrombus material failed in five of six access models with diameters of 9 mm, even though ultrasound energy was applied for the maximum of 15 min.

Conclusion: In a clotted hemodialysis shunt model, successful ultrasound thrombolysis was limited to small access diameters and small amounts of thrombus.

Key words

Thrombosis, venous Thrombosis, mechanical Dialysis, shunts Interventional procedures, experimental Ultrasound Grafts, interventional procedure 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brosh D, Miller HI, Herz I, Laniado S, Rosenschein U (1998) Ultra-sound angioplasty: An update review. Int J Cardiovasc Interv 1:11–18Google Scholar
  2. 2.
    Miller DL (1987) A review of the ultrasonic bioeffects of microsonication, gas-body activation and related cavitation-like phenomena. Ultrasound Med Biol 13:443–470PubMedCrossRefGoogle Scholar
  3. 3.
    Rosenschein U, Rassin T (1998) Ultrasound thrombolysis. Sci Med 5:36–43Google Scholar
  4. 4.
    Rosenschein U, Frimerman A, Laniado S, Miller HI (1994) Study of the mechanism of ultrasound angioplasty from human thrombi and bovine aorta. Am J Cardiol 74:1263–1266PubMedCrossRefGoogle Scholar
  5. 5.
    Rosenschein U, Bernstein JJ, DiSegni E, Kaplinsky E, Bernheim J, Rozenzsajn LA (1990) Experimental ultrasonic angioplasty: Disruption of artherosclerotic plaques and thrombi in vitro and arterial recanalization in vivo. J Am Coll Cardiol 15:711–717PubMedCrossRefGoogle Scholar
  6. 6.
    Schmitz-Rode T, Günther RW, Müller-Leisse C (1991) US-assisted aspiration thrombeetomy: In vitro investigations. Radiology 178:677–679PubMedGoogle Scholar
  7. 7.
    Sobbe A, Stumpff U, Trübestein G, Figge H, Kozuschek W (1974) Thrombolysis by ultrasound. (in German) Klin Wochenschr 52:1117–1121PubMedCrossRefGoogle Scholar
  8. 8.
    Stumpff U, Pohlman R, Trübestein G (1975) A new method to cure thrombi by ultrasonic cavitation. Ultrason Int Conf Proc 13:273–275Google Scholar
  9. 9.
    Trübestein G (1978) Removal of intravascular clots by ultrasound: Experimental study of a new method and its clinical use. (in German) Fortschr Med 96:755–760PubMedGoogle Scholar
  10. 10.
    Siegel RJ, Cumberland DC, Myler RK, DonMichael TA (1989) Percutaneous ultrasonic angioplasty: initial clinical experience. Lancet II:772–7744CrossRefGoogle Scholar
  11. 11.
    Rosenschein U, Rozenzsajn LA, Kraus L, Marboe CC, Watkins JF, Rose EA, David D, Cannon PJ, Weinstein JS (1991) Ultrasonic angioplasty in totally occluded peripheral arteries: Initial clinical, histological, and angiographic results. Circulation 83:1976–1986PubMedGoogle Scholar
  12. 12.
    Siegel RJ, Cumberland DC, Crew JR (1992) Ultrasound recanalization of diseased arteries: From experimental studies to clinical application. Surg Clin North Am 72:879–895PubMedGoogle Scholar
  13. 13.
    Monteverde C, Velez M, Jauregui R, Garcia R, Nava G (1991) Angiosonoplasty: Percutaneous intravascular plaque ablation with ultrasound. Late results in peripheral arteries. Circulation 84 [Suppl II]:69Google Scholar
  14. 14.
    Yock PG, Fitzgerald PJ (1997) Catheter-based ultrasound thrombolysis: Shake, rattle, and reperfuse. Circulation 95:1360–1362PubMedGoogle Scholar
  15. 15.
    Rosenschein U, Roth A, Rassin T, Basan S, Laniado S, Miller HI (1997) Analysis of coronary ultrasound thrombolysis: Endpoints in acute myocardial infarction (ACUTE Trial). Results of the feasibility phase. Circulation 95:1411–1416PubMedGoogle Scholar
  16. 16.
    Rosenschein U, Gaul G, Erbel R, Amann F, Velasguez D, Stoerger H, Simon R, Gomez G, Troster J, Bartorelli A, Pieper M, Kyriakides Z, Laniado S, Miller HI, Cribier A, Fajadet J (1999) Percutaneous transluminal therapy of occluded saphenous vein grafts: Can the challenge be met with ultrasound thrombolysis? Circulation 99:26–29PubMedGoogle Scholar
  17. 17.
    Schmitz-Rode T, Bohndorf K, Günther RW (1993) Recanalization of thrombotic hemodialysis shunts by oscillational aspiration thrombeetomy and mesh basket treatment. (in German) Fortschr Röntgenstr 158:49–52CrossRefGoogle Scholar
  18. 18.
    Shlansky-Goldberg RD, Cines DB, Sehgal CM (1996) Catheter-delivered ultrasound potentiates in vitro thrombolysis. J Vase Interv Radiol 7:313–320CrossRefGoogle Scholar
  19. 19.
    Tachibana K (1992) Enhancement of fibrinolysis with ultrasound energy. J Vase Interv Radiol 3:299–303CrossRefGoogle Scholar
  20. 20.
    Luo H, Nishioka T, Fishbein MC, Cercek B, Forrester JS, Kim CJ, Berglund H, Siegel RJ (1996) Transcutaneous ultrasound augments lysis of arterial thrombi in vivo. Circulation 94:775–778PubMedGoogle Scholar
  21. 21.
    Tachibana K, Tachibana S (1995) Albumin microbubble echo-contrast material as an enhancer for ultrasound accelerated thrombolysis. Cir-culation 92:1148–1150Google Scholar
  22. 22.
    Overbosch EH, Pattynama PMT, Aarts HJCNM, Schultze Kool LJ, Hermans J, Reekers JA (1996) Occluded hemodialysis shunts: Dutch multicenter experience with the Hydrolyser catheter. Radiology 201:485–4888PubMedGoogle Scholar
  23. 23.
    Van Ommen V, Van der Veen FH, Daemen MJ, Habets J, Wellens HJ (1994) In vivo evaluation of the Hydrolyser hydrodynamic thrombeetomy catheter. J Vase Interv Radiol 5:823–826CrossRefGoogle Scholar
  24. 24.
    Uflacker R, Rajagopalan PR, Vujic I, Stutley JE (1996) Treatment of thrombosed dialysis access grafts: Randomized trial of surgical thrombeetomy versus mechanical thrombectomy with the Amplatz device. J Vase Interv Radiol 7:185–192CrossRefGoogle Scholar
  25. 25.
    Tadavarthy SM, Murray PD, Inampudi S, Nazarian GK, Amplatz K (1994) Mechanical thrombeetomy with the Amplatz device: Human experience. J Vase Interv Radiol 5:715–724CrossRefGoogle Scholar
  26. 26.
    Vorwerk D, Sohn M, Schurmann K, Hoogeveen Y, Gladziwa U, Günther RW (1994) Hydrodynamic thrombeetomy of hemodialysis fistulas: First clinical results. J Vase Interv Radiol 5:813–821CrossRefGoogle Scholar
  27. 27.
    Wildberger J, Schmitz-Rode T, Wein BB, Günther RW (1999) Mechanical thrombeetomy in hemodialysis access shunts using a 5 F pigtail rotational device: In-vitro and in-vivo investigations. Invest Radiol 34:489–495PubMedCrossRefGoogle Scholar
  28. 28.
    Trerotola SO, Lund GB, Scheel PJ, Savader SJ, Venbrux AC, Osterman FA (1994) Thrombosed dialysis access grafts: Percutaneous mechanical declotting without urokinase. Radiology 191:721–726PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc 2001

Authors and Affiliations

  • Joachim Ernst Wildberger
    • 1
  • Thomas Schmitz-Rode
    • 1
  • Patrick Haage
    • 1
  • Joachim Pfeffer
    • 1
  • Alexander Ruebben
    • 1
  • Rolf W. Günther
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity of Technology AachenAachenGermany

Personalised recommendations