Korean Journal of Nephrology 1999;18(2):277-283.

혈액투석 환자에서 동정맥루 협착 및 폐쇄 치료법으로서 경피적 혈관 확장술의 임상적 의의 (The Effect of Percutaneous Angioplasty on the Treatment of Stenosis and Obstruction of Arteriovenous Fistula in the Hemodialysis Patients)

김영옥, 신미정, 송호철, 윤선애, 김용수, 최의진, 송하헌, 이해규, 장윤식, 방병기 (Young Ok Kim, Mi Jung Shin, Ho Chul Song, Sun Ae Yoon, Yong Soo Kim, Euy Jin Choi, Ha Hun Song, Hae Kyu Lee and Byung Kee Bang)

Abstract

Providing satisfactory vascular access for hemodialysis remains one of the most challenging problems confronting nephrologists. We evaluated the effect of percutaneous angioplasty on the treatment of stenosis and obstruction of arteriovenous fistula (AVF) in the chronic hemodialysis patients. Twenty-six dilatations of stenotic or occluded lesions in hemodialysis access fistulas were performed. The type of AVF was an native AVF in 19 cases and a graft in 7 cases. The lesions involved fore arm vein in 16 cases and an upper arm veins in 10 cases. Indications for angioplasty included acute obstruction of blood flow(9 patients), increased venous dialysis(VDP) or urea recirculation ratio(URR)(8 patients), arm edema or difficulty in needle placement(6 patients), poor maturation before first needling(3 patients). The PTA initially succeeded in 23 of 26 cases(88.5%) and 3 month patency rate was 80.5%. In 8 patients with increased VDP or URR, both VDP and URR significantly decreased after PTA (VDP;118.1±20.7mmHg vs 89.5±23.8 mmHg, P= 0.04, URR;23.9±18.4% vs 7.5±6.1%, P=0.02). The complications of PTA were vessel rupture(1 patient) and hematoma(2 patients). In conclusion, PTA seems to be effective therapy in the treatment of stenosis and obstruction of arteriovenous fistula(AVF) without serious complications in the chronic hemodialysis patients.