Objective
To study the efficacy of using low-dose thrombolytic agent Alteplase on restoring patency of thrombotic or occluded cuffed tunneled catheters (CTCs) without the need for more invasive procedures.
Patients and methods
We performed a prospective study of 35 patients with malfunctioning CTCs during the period from August 2018 to August 2021, who were attending the emergency room or outpatient clinic at Ain Shams University Hospitals. We excluded patients having absolute or relative contraindication to thrombolytic therapy, infected CTCs, and CTCs with malposition. Clinical records included patient demographics, etiology, and any previous catheter insertion. Procedural details included access site, equipment used, procedural outcomes, and complications. After providing written informed consent, initially we used 2.5 mg of Alteplase in each limb of CTCs. Each limb was connected to an infusion pump at a rate of 0.5 mg Alteplase per hour. CTCs were tested at 6, 12, 18, and 24 h; smooth injection and withdrawal of each limb were the primary end points. Successful hemodialysis session was the secondary end point. Follow-up of patients up to 3 years was recorded.
Results
All our patients were permanently dependent on CTCs. There were 19 males and 16 females, with ages ranging between 18 and 65 years (mean±SD, 55.91 ± 8.20 years). We had 21 femoral, three right internal jugular, and 11 left internal jugular CTCs. Patients were treated with a low dose of thrombolytic agent Alteplase with a mean±SD 9.83 ± 5.03 h and had a median follow-up of 36 months. The median duration of CTCs after the procedure was 24 months. Only three (8.5%) CTCs were changed.
Conclusions
Treating malfunctioning CTCs with low-dose Alteplase is an excellent choice. The technique has good 1, 2, and 3 years of follow-up and is associated with significant clinical improvement and few complications.