Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Usefulness of Interventional Treatment for Dysfunctional Hemodialysis Shunts of the Upper Arm by Means of the Retrograde Transradial Approach

상완 혈액투석경로의 기능부전에 대한 인터벤션 치료 시 역행성 경요골동맥 접근법의 유용성

  • Shin, Hwa-Seon (Department of Radiology, Gyeongsang National University Hospital) ;
  • Shin, Tae-Beom (Department of Radiology, Institute of Health Science, Gyeongsang National University Hospital) ;
  • Na, Jae-Beom (Department of Radiology, Gyeongsang National University Hospital) ;
  • Jung, Seong-Hoon (Department of Radiology, Gyeongsang National University Hospital) ;
  • Kim, Hyun-Jung (Department of Nephology, Gyeongsang National University Hospital) ;
  • Lee, Jung-Eun (Department of Chest Surgery, Gyeongsang National University Hospital) ;
  • Song, Yun-Gyu (Department of Radiology, Masan Samsung Hospital, Sungkyunkwan University) ;
  • Jung, Gyoo-Sik (Department of Radiology, Kosin University Hospital)
  • 신화선 (경상대학교병원 영상의학과) ;
  • 신태범 (경상대학교병원 영상의학과, 건강과학 연구원) ;
  • 나재범 (경상대학교병원 영상의학과) ;
  • 정성훈 (경상대학교병원 영상의학과) ;
  • 김현정 (경상대학교병원 신장내과) ;
  • 이정은 (경상대학교병원 흉부외과) ;
  • 송윤규 (마산삼성병원 영상의학과) ;
  • 정규식 (고신의료원 영상의학과)
  • Received : 2010.06.13
  • Accepted : 2010.07.22
  • Published : 2010.11.01
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Abstract

Purpose: This study was designed to evaluate the technical feasibility and clinical outcome of endovascular intervention using the retrograde transradial approach to treat dysfunctional hemodialysis shunts of the upper arms. Materials and Methods: During the last 3 years, sixteen procedures were performed by the transradial approach in 13 patients with dysfunctional hemodialysis shunts of the upper arms. The radial artery was accessed with the use of 20-gauge needle and a 6-Fr sheath. Angiography was performed using a 5-Fr catheter placed in the brachial artery, and then the interventional procedure was performed. The technical and clinical success rates, complications and patency rates were evaluated. Results: Fistulography and percutaneous transluminal angioplasty via the transradial approach were performed in 16 cases of the 13 patients. Fistulography demonstrated stenosis in 7 cases and occlusions in 9 cases. Lesion multiplicity was identified in 9 out of 16 cases. Balloon angioplasty was performed in all cases and a stent was placed to overcome restenosis or to treat venous rupture in two cases. The technical success rate of balloon angioplasty was 87.5% (14/16) and the technical success rate with including stent insertion was 100% (16/16). The clinical success rate was 93.8%. There was one procedural-related complication. The primary patency rates at 6 and 12 months were 84.6% and 74%, respectively. Conclusion: The transradial approach seems to be technically feasible and effective for the management of insufficient hemodialysis shunts of the upper arms.

목적: 상완에 위치한 영구적 혈액투석경로 기능부전 환자에서 역행성 경요골동맥 접근법의 임상적 유용성에 대하여 알아보고자 한다. 대상과 방법: 최근 3년간 상완의 영구적 혈액투석경로의 기능부전 환자 중 경요골동맥 접근법으로 인터벤션 시술을 시행한 13명(16예)를 대상으로 하였다. 20게이지 천자침으로 요골동맥을 천자하여 6 Fr 혈관초를 삽입하고, 5 Fr 도관을 상완동맥에 위치시킨 후 혈관조영술을 시행하여 병변을 확인하고 인터벤션 시술을 시행하였다. 시술의 기술적 및 임상적 성공률, 장기 개통성, 시술과 연관된 합병증을 조사하였다．결과: 모든 예에서 요골 동맥을 통한 혈관조영술을 성공적으로 시행하였고 단일병변 7예, 다발성병변 9예이었고, 협착 7예, 폐쇄 9예이었다. 모든 예에서 풍선확장술을 시행하였으며 풍선확장술에 실패하거나 혈관파열이 발생한 2예에서 스텐트삽입술을 시행하였다. 풍선확장술의 기술적 성공률은 87.5% (14/16)였으며, 30% 이상의 잔여협착에 대한 스텐트 시술을 포함한 기술적 성공률은 100% (16/16)였다. 이 중 15예에서 시술 후 성공적인 투석을 시행하여 93.8%의 임상적 성공률을 보였다. 1명의 환자에서 시술 2일 후 시술 부위의 감염이 발생하여 패혈증으로 사망하였다. 12명 생존 환자에서 6개월, 12개월 누적 개통률은 84.6%, 74%였다. 결론: 상완의 혈액투석경로 기능부전 환자에서 경요골동맥 접근법을 통한 인터벤션 시술은 임상적으로 유용한 방법으로 생각된다.

Keywords

References

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