Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Bare-Metal Stent in Dysfunctional Hemodialysis Access: An Assessment of Circuit Patency according to Access Type and Stent Location

혈액투석 접근로 기능부전에서의 비피복형 스텐트: 접근로 종류와 스텐트 위치에 따른 개통률 평가

  • Kyungmin Lee (Department of Radiology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Je Hwan Won (Department of Radiology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Yohan Kwon (Department of Radiology, Ajou University Hospital, Ajou University School of Medicine) ;
  • Su Hyung Lee (Department of Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Jun Bae Bang (Department of Surgery, Ajou University Hospital, Ajou University School of Medicine) ;
  • Jinoo Kim (Department of Radiology, Ajou University Hospital, Ajou University School of Medicine)
  • 이경민 (아주대학교 의과대학 영상의학교실) ;
  • 원제환 (아주대학교 의과대학 영상의학교실) ;
  • 권요한 (아주대학교 의과대학 영상의학교실) ;
  • 이수형 (아주대학교 의과대학 외과학교실) ;
  • 방준배 (아주대학교 의과대학 외과학교실) ;
  • 김진우 (아주대학교 의과대학 영상의학교실)
  • Received : 2022.05.08
  • Accepted : 2022.06.29
  • Published : 2023.01.01
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Abstract

Purpose To evaluate the circuit patency after nitinol bare-metal stent (BMS) placement according to the type of access and location of the stent in dysfunctional hemodialysis access. Materials and Methods Between January 2017 and December 2019, 159 patients (mean age, 64.1 ± 13.2 years) underwent nitinol BMS placement for dysfunctional access. The location of stents was as follows: 18 brachiocephalic vein, 51 cephalic arch, 40 upper arm vein, 10 juxta-anastomotic vein, 7 arteriovenous (AV) anastomosis, and 33 graft-vein (GV) anastomosis. Circuit patency was evaluated by the Kaplan-Meier method, and cox regression model. Results A total of 159 stents were successfully deployed in 103 AV fistula (AVF) and 56 AV graft (AVG). AVG showed lower primary and secondary patency at 12-months compared with AVF (primary patency; 25.0% vs. 44.7%; p = 0.005, secondary patency; 76.8% vs. 92.2%; p = 0.014). Cox regression model demonstrated poorer primary patency at 12 months after stenting in the cephalic arch and GV anastomosis compared with the other sites. Conclusion AVF showed better primary and secondary circuit patency at 12 months following the placement of BMS compared with AVG. Stents in the cephalic arch and GV anastomosis were associated with poorer primary patency at 12 months compared to those in other locations.

목적 기능장애 혈액투석 접근로에서 나이티놀 비피복형 스텐트 설치 후 접근로 유형과 스텐트의 위치에 따른 개통성을 평가하고자 한다. 대상과 방법 2017년 1월과 2019년 12월 사이에 159명의 환자(평균 연령, 64.1 ± 13.2세)가 혈액투석 접근로 기능장애를 치료를 위해 나이티놀 스텐트를 설치하였다. 스텐트의 위치는 다음과 같다; 18개 팔머리 정맥, 51개 노쪽피부정맥궁, 40개 위팔 정맥, 10개 문합부위 인접 정맥, 7개 동정맥 문합부 및 33개 인조혈관-정맥 문합부. 12개월 개통률은 카플란-마이어 방법과 콕스 회귀 모델로 평가하였다. 결과 총 159개의 스텐트가 103개의 자가동정맥루와 56개의 인조혈관접근로에 성공적으로 설치되었다. 인조혈관접근로는 자가동정맥루에 비해 12개월 일차 및 이차 개통률이 더 낮았다(일차 개통률; 25.0%대 44.7%; p = 0.005, 이차 개통률; 76.8%대 92.2%; p = 0.014). 스텐트 설치 후 노쪽피부정맥궁 및 인조혈관-정맥 문합부에서 다른 부위에 비해 12개월 일차 개통성이 불량하였다. 결론 나이티놀 비피복형 스텐트 설치 후 자가동정맥루는 인조혈관접근로와 비교하여 더 좋은 12개월 일차 및 이차 개통률을 보인다. 노쪽피부정맥궁 및 인조혈관-정맥 문합부의 스텐트는 다른 위치의 스텐트에 비해 더 낮은 12개월 일차 개통률을 보인다.

Keywords

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