Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Safety and Efficacy of the Percutaneous Manual Aspiration Thrombectomy Technique to Treat Thrombotic Occlusion of Native Arteriovenous Fistulas for Hemodialysis

혈액투석용 자가혈관 동정맥루의 혈전을 동반한 폐색에서 경피적 수동 흡인 혈전제거술의 안정성과 유용성

  • Sang Eun Yoon (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Sun Young Choi (Department of Radiology, Ewha Womans University Mokdong Hospital) ;
  • Soo Buem Cho (Department of Radiology, Ewha Womans University College of Medicine)
  • 윤상은 (이화여자대학교 목동병원 영상의학과) ;
  • 최선영 (이화여자대학교 목동병원 영상의학과) ;
  • 조수범 (이화여자대학교 의과대학 영상의학교실)
  • Received : 2019.06.19
  • Accepted : 2019.08.24
  • Published : 2020.03.01
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Abstract

Purpose To evaluate the safety and efficacy of the percutaneous manual aspiration thrombectomy technique to treat thrombotic occlusion of native arteriovenous fistulas. Materials and Methods A retrospective review of 20 patients who underwent percutaneous manual aspiration thrombectomy for native thrombotic arteriovenous fistula occlusion from March 2012 to December 2017 was performed. We evaluated technical and clinical success rates and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. Results Percutaneous manual aspiration thrombectomy was performed in 20 patients (n = 20) with concomitant balloon angioplasty. The overall technical and clinical success rates were both 85% (n = 17). The native arteriovenous fistulas, based on their site, were the left radiocephalic (n = 13), left brachiocephalic (n = 4), and right radiocephalic (n = 3) fistulas. An underlying stenosis was detected in the juxta-anastomotic venous site (n = 16), outflow draining vein (n = 12), and central vein (n = 4). The primary and secondary patency rates at 1, 3, 6, and 12 months were 100%, 70.6%, 70.6%, and 56.5% and 100%, 94.1%, 94.1%, and 86.9%, respectively. There were no complications associated with procedure. Conclusion Percutaneous manual aspiration thrombectomy is a safe and effective method to treat thrombotic native arteriovenous fistula occlusion.

목적 혈액투석용 자가혈관 동정맥루의 혈전을 동반한 폐색에서 경피적 수동 흡인 혈전제거술의 안전성과 유용성에 대해 평가하고자 한다. 대상과 방법 2012년 3월부터 2017년 12월까지 자가혈관 동정맥루의 혈전을 동반한 폐색으로 내원하여 경피적 혈관 내 시술을 시행 받은 20명의 환자를 후향적으로 분석하였다. 기술적 및 임상적 시술 성공률, 1차 및 2차 개통률, 그리고 시술에 따른 합병증을 분석하였다. 결과 총 20명의 환자에서 20회의 경피적 혈관 내 시술을 시행하였다. 모든 환자에서 혈전을 제거하기 위해 경피적 수동 흡인 혈전제거술을 시행하였고, 협착이 동반된 경우 풍선카테터를 이용한 혈관성형술을 함께 시행하였다. 17명의 환자는 혈전이 제거되어 혈류가 정상적으로 회복되었고(기술적 성공률 85%), 17명 환자 모두 시술 직후 혈액투석이 정상적으로 시행되었다(임상적 성공률 85%). 동정맥루 위치는 좌측 요골두정맥루가 13명, 좌측 상완두정맥루가 4명, 우측 요골두정맥루가 3명이었다. 동반된 협착 부위는 문합부 주위 정맥이 16예, 원위부 배출정맥이 12예, 중심정맥이 4예였다. 1차 및 2차 개통률은 1, 3, 6, 12개월에서 각각 100%, 70.6%, 70.6%, 56.5% 및 100%, 94.1%, 94.1%, 86.9%였다. 시술과 관련된 합병증은 없었다. 결론 혈액투석용 자가혈관 동정맥루에서 혈전을 동반한 폐색의 치료로서 경피적 수동 흡인 혈전제거술은 안전하고 유용한 시술이다.

Keywords

References

  1. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48 Suppl 1:S248-S273 https://doi.org/10.1053/j.ajkd.2006.04.040
  2. Palder SB, Kirkman RL, Whittemore AD, Hakim RM, Lazarus JM, Tilney NL. Vascular access for hemodialysis. Patency rates and results of revision. Ann Surg 1985;202:235-239 https://doi.org/10.1097/00000658-198508000-00015
  3. Tordoir JH, Bode AS, Peppelenbosch N, Van der Sande FM, De Haan MW. Surgical or endovascular repair of thrombosed dialysis vascular access: is there any evidence? J Vasc Surg 2009;50:953-956 https://doi.org/10.1016/j.jvs.2009.06.058
  4. Ponikvar R. Surgical salvage of thrombosed arteriovenous fistulas and grafts. Ther Apher Dial 2005;9:245-249 https://doi.org/10.1111/j.1774-9987.2005.00264.x
  5. Georgiadis GS, Lazarides MK, Lambidis CD, Panagoutsos SA, Kostakis AG, Bastounis EA, et al. Use of short PTFE segments (<6 cm) compares favorably with pure autologous repair in failing or thrombosed native arteriovenous fistulas. J Vasc Surg 2005;41:76-81 https://doi.org/10.1016/j.jvs.2004.10.034
  6. Cho SK, Han H, Kim SS, Lee JY, Shin SW, Do YS, et al. Percutaneous treatment of failed native dialysis fistulas: use of pulse-spray pharmacomechanical thrombolysis as the primary mode of therapy. Korean J Radiol 2006;7:180-186 https://doi.org/10.3348/kjr.2006.7.3.180
  7. Shatsky JB, Berns JS, Clark TW, Kwak A, Tuite CM, Shlansky-Goldberg RD, et al. Single-center experience with the Arrow-Trerotola Percutaneous Thrombectomy Device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol 2005;16:1605-1611 https://doi.org/10.1097/01.RVI.0000182157.48697.F5
  8. Overbosch EH, Pattynama PM, Aarts HJ, Schultze Kool LJ, Hermans J, Reekers JA. Occluded hemodialysis shunts: dutch multicenter experience with the hydrolyser catheter. Radiology 1996;201:485-488 https://doi.org/10.1148/radiology.201.2.8888246
  9. Turmel-Rodrigues L, Raynaud A, Louail B, Beyssen B, Sapoval M. Manual catheter-directed aspiration and other thrombectomy techniques for declotting native fistulas for hemodialysis. J Vasc Interv Radiol 2001;12:1365-1371 https://doi.org/10.1016/S1051-0443(07)61691-1
  10. Cohen MA, Kumpe DA, Durham JD, Zwerdlinger SC. Improved treatment of thrombosed hemodialysis access sites with thrombolysis and angioplasty. Kidney Int 1994;46:1375-1380 https://doi.org/10.1038/ki.1994.407
  11. Rodkin RS, Bookstein JJ, Heeney DJ, Davis GB. Streptokinase and transluminal angioplasty in the treatment of acutely thrombosed hemodialysis access fistulas. Radiology 1983;149:425-428 https://doi.org/10.1148/radiology.149.2.6226058
  12. Eisenbud DE, Brener BJ, Shoenfeld R, Creighton D, Goldenkranz RJ, Brief DK, et al. Treatment of acute vascular occlusions with intra-arterial urokinase. Am J Surg 1990;160:160-164; discussion 164-165 https://doi.org/10.1016/S0002-9610(05)80298-3
  13. Drasler WJ, Jenson ML, Wilson GJ, Thielen JM, Protonotarios EI, Dutcher RG, et al. Rheolytic catheter for percutaneous removal of thrombus. Radiology 1992;182:263-267 https://doi.org/10.1148/radiology.182.1.1727293
  14. Lajvardi A, Trerotola SO, Strandberg JD, Samphilipo MA, Magee C. Evaluation of venous injury caused by a percutaneous mechanical thrombolytic device. Cardiovasc Intervent Radiol 1995;18:172-178 https://doi.org/10.1007/BF00204145
  15. Gray RJ, Sacks D, Martin LG, Trerotola SO. Reporting standards for percutaneous interventions in dialysis access. Technology Assessment Committee. J Vasc Interv Radiol 1999;10:1405-1415 https://doi.org/10.1016/S1051-0443(99)70252-6
  16. Quencer KB, Arici M. Arteriovenous fistulas and their characteristic sites of stenosis. AJR Am J Roentgenol 2015;205:726-734 https://doi.org/10.2214/AJR.15.14650
  17. Weiss MF, Scivittaro V, Anderson JM. Oxidative stress and increased expression of growth factors in lesions of failed hemodialysis access. Am J Kidney Dis 2001;37:970-980 https://doi.org/10.1016/S0272-6386(05)80013-7
  18. Stracke S, Konner K, Kostlin I, Friedl R, Jehle PM, Hombach V, et al. Increased expression of TGF-beta1 and IGF-I in inflammatory stenotic lesions of hemodialysis fistulas. Kidney Int 2002;61:1011-1019 https://doi.org/10.1046/j.1523-1755.2002.00191.x
  19. Rajan DK, Clark TW, Patel NK, Stavropoulos SW, Simons ME. Prevalence and treatment of cephalic arch stenosis in dysfunctional autogenous hemodialysis fistulas. J Vasc Interv Radiol 2003;14:567-573 https://doi.org/10.1097/01.RVI.0000071090.76348.BC
  20. Iimura A, Nakamura Y, Itoh M. Anatomical study of distribution of valves of the cutaneous veins of adult's limbs. Ann Anat 2003;185:91-95 https://doi.org/10.1016/S0940-9602(03)80019-5
  21. Sivananthan G, Menashe L, Halin NJ. Cephalic arch stenosis in dialysis patients: review of clinical relevance, anatomy, current theories on etiology and management. J Vasc Access 2014;15:157-162 https://doi.org/10.5301/jva.5000203
  22. Maleux G, De Coster B, Laenen A, Vaninbroukx J, Meijers B, Claes K, et al. Percutaneous rheolytic thrombectomy of thrombosed autogenous dialysis fistulas: technical results, clinical outcome, and factors influencing patency. J Endovasc Ther 2015;22:80-86 https://doi.org/10.1177/1526602814566378
  23. Yang CC, Yang CW, Wen SC, Wu CC. Comparisons of clinical outcomes for thrombectomy devices with different mechanisms in hemodialysis arteriovenous fistulas. Catheter Cardiovasc Interv 2012;80:1035-1041 https://doi.org/10.1002/ccd.24408
  24. Won JH, Bista AB, Bae JI, Oh CK, Park SI, Lee JH, et al. A venotomy and manual propulsion technique to treat native arteriovenous fistulas occluded by thrombi. AJR Am J Roentgenol 2012;198:460-465 https://doi.org/10.2214/AJR.10.6230
  25. Turmel-Rodrigues L, Pengloan J, Rodrigue H, Brillet G, Lataste A, Pierre D, et al. Treatment of failed native arteriovenous fistulae for hemodialysis by interventional radiology. Kidney Int 2000;57:1124-1140 https://doi.org/10.1046/j.1523-1755.2000.00940.x