Efficacy of percutaneous transluminal angioplasty in the management of chronic hemodialysis patients

Abstract

2000年4月からの19ヵ月間に行った18例24回のPTAについてretrospectiveに検討した.男性11例, 女性7例, 平均63歳であった.狭窄部位は, 吻合部5病変, シャント静脈22病変, 計27病変であった.手技的成功率は82.5%, また一次開存率は1ヵ月で82.6%, 3ヵ月で74.5%, 半年で67.5%であった.5例で二次PTAを施行し, その開存率は一次開存率と有意差を認めなかった.また一次PTA群と外科的再建群での開存率に有意差を認めなかった

Percutaneous transluminal angioplasty (PTA) has gained wide acceptance as an effective technique for the dilatation of stenoses in the arterial tree. We evaluated the long-term results of vascular access in a group undergoing hemodialysis, in particular the effects of PTA. Twenty-four percutaneous procedures were performed on 18 patients. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations performed at dialysis. The initial success rate was 87.5%, with 1-, 6-, and 18-month patency rates of 82.6, 67.5, and 38.5%, respectively. There was no difference between primary and secondary patency rates. The assisted primary patency rates for PTA and surgical revision were not significantly different. Although neither surgical nor endovascular management resulted in long-term function for the majority of shunts after stenosis or thrombosis, endovascular treatment can extend the life of dialysis shunts with results similar to surgical revision. Transluminal dilatation may be performed in appropriate cases to obviate the need for surgery.