Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Assessment of Venographic Abnormalities during Replacement of Dysfunctional Tunneled Hemodialysis Catheters and Outcome of Endovascular Salvage Techniques

기능부전 터널식 투석용 도관의 교체 시 시행한 정맥조영술 결과의 분석과 혈관 내 치료 기술의 결과

  • Suh, Pae Sun (Department of Radiology, Ajou University School of Medicine, Ajou University Hospital) ;
  • Park, Seon Young (Department of Radiology, Ajou University School of Medicine, Ajou University Hospital) ;
  • Kim, Jinoo (Department of Radiology, Ajou University School of Medicine, Ajou University Hospital) ;
  • Oh, Chang Kwon (Department of Surgery, Ajou University School of Medicine, Ajou University Hospital) ;
  • Lee, Su Hyung (Department of Surgery, Ajou University School of Medicine, Ajou University Hospital) ;
  • Won, Je Hwan (Department of Radiology, Ajou University School of Medicine, Ajou University Hospital)
  • 서배선 (아주대학교 의과대학 아주대학교병원 영상의학과) ;
  • 박선영 (아주대학교 의과대학 아주대학교병원 영상의학과) ;
  • 김진우 (아주대학교 의과대학 아주대학교병원 영상의학과) ;
  • 오창권 (아주대학교 의과대학 아주대학교병원 외과) ;
  • 이수형 (아주대학교 의과대학 아주대학교병원 외과) ;
  • 원제환 (아주대학교 의과대학 아주대학교병원 영상의학과)
  • Received : 2018.01.09
  • Accepted : 2018.05.16
  • Published : 2018.09.01
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Abstract

Purpose: To assess the venographic findings of central venous abnormalities before exchanging dysfunctional tunneled hemodialysis catheters and the outcome of endovascular salvage techniques. Materials and Methods: A total of 110 episodes of tunneled hemodialysis catheter dysfunction in 78 patients undergoing catheter-directed hemodialysis treatment from January 2011 to December 2015 were retrospectively evaluated. Venography was performed before catheter exchange, and the following procedures were conducted according to the venographic findings: balloon disruption of a fibrin sheath, angioplasty for central vein stenosis, or stent insertion. Technical success was defined as at least one successful session of hemodialysis with the exchanged catheter. Patients were followed until the study endpoints or the last hospital visit. Results: Venography showed abnormalities in patients with 67 of the 110 exchanged catheters, including central vein stenosis (n = 27), fibrin sheath formation (n = 17), and thrombus formation (n = 12). Technical success was confirmed in all cases. The estimated 30-day catheter patency for all assessable catheters was 61.7%. Nine catheters were removed during the follow-up period because of suspected catheter-related infections. Conclusion: In approximately 60% of cases of dysfunctional tunneled hemodialysis catheter, abnormal venographic findings were observed in the patients. Following appropriate endovascular techniques could be helpful in improving catheter patency with a low risk of procedure-related complications.

목적: 기능부전 터널식 투석용 도관의 교체 전에 시행한 정맥조영술 소견을 분석하고 이에 따른 혈관 내 중재시술의 결과에 대해 분석하였다. 대상과 방법: 2011년 1월에서 2015년 12월 사이에 터널식 투석용 도관을 통하여 투석을 받는 환자 중 도관의 기능부전으로 교체를 시행 받은 78명(110예)을 대상으로 후향적으로 연구하였다. 도관의 교체 전 정맥조영술의 결과에 따라 적절한 중재시술을 시행하였다. 기술적 성공은 도관 교체 후 적어도 한 번 이상의 성공적인 투석의 진행으로 정의하였다. 환자들은 도관 제거일 또는 마지막 병원 방문일까지 추적 관찰하였다. 결과: 67개의 도관의 교체 전 정맥조영술에서 중심 정맥 협착, 섬유소집, 혈전 형성 등의 비정상적인 소견이 관찰되었다. 모든 증례에서 기술적 성공이 확인되었으며, 30일 도관 생존율은 61.7%였다. 추적 기간 동안 도관감염이 의심되는 9개의 도관을 제거하였다. 결론: 기능 부전 터널식 투석용 도관의 교체 시 약 60%에서 비정상적인 정맥조영술 소견이 관찰되었다. 이에 따른 적절한 혈관 내 중재술을 시행한 결과 도관 생존율은 이전의 다른 연구들과 비견할 만하였으며 시술과 관련된 합병증의 위험도는 낮았다.

Keywords

References

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