Korean Journal of Radiology

  • 제16권2호
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  • Pages.349-356
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  • 2015
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Endovascular Recanalization of a Thrombosed Native Arteriovenous Fistula Complicated with an Aneurysm: Technical Aspects and Outcomes

  • Ahn, Su Yeon (Department of Radiology, Seoul National University Hospital, College of Medicine, Seoul National University) ;
  • So, Young Ho (Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Choi, Young Ho (Department of Radiology, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Jung, In Mok (Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center) ;
  • Chung, Jung Kee (Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center)
  • 투고 : 2014.11.20
  • 심사 : 2015.01.03
  • 발행 : 2015.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. Materials and Methods: Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. Results: The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxta-anastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. Conclusion: Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

키워드

참고문헌

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피인용 문헌

  1. Thrombosed native hemodialysis fistulas: Technical and clinical outcomes of endovascular recanalization and factors influencing patency vol.20, pp.6, 2019, https://doi.org/10.1177/1129729819848931
  2. Dialysis Shunt Thrombectomy Utilizing a Rotational Thrombectomy Device in Patients with Pseudoaneurysms vol.4, pp.2, 2020, https://doi.org/10.4103/ajir.ajir_8_20
  3. Stent graft deployment in haemodialysis fistula: patency rates in partially thrombosed aneurysm and residual thrombi vol.14, pp.3, 2015, https://doi.org/10.1093/ckj/sfz193