Korean Journal of Nephrology 2000;19(6):1047-1052.

혈관 확장술에 실패한 동정맥루의 상부정맥 폐쇄 및 협착증에 대한 혈관내 스텐트의 치료효과 (Proximal Vein Obstruction or Stenosis Failed to Angioplasty in Hemodialysis Patients : Treatment with Endovascular Stent)

김영옥(Young Ok Kim),윤선애(Sun Ae Yoon),방병기(Byung Gee Bang),김병수(Byung Soo Kim),송하헌(Ha Hun Song),김기태(Gee Tae Kim),고기영(Gee Young Ko),신미정(Mi Jung Shin),박주현(Joo Hyun Park),양철우(Chul Woo Yang),김용수(Yong Soo Kim)

Abstract

Although percutaneous angioplasty is effectively used in the treatment of vascular access stenosis in hemodialysis patients, it has low initial success rate and high recurrence rate for proximal vein obstruction or stenosis. We evaluated the effect of endovascular stent placement on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients. Wallstent was placed in 8 hemodialysis patients with vascular access obstruction or stenosis. All lesions were proximal to a functioning access which had been created one month to 4 years prior to on set of symptoms. Of the total patients, 4 patients had central vein stenosis(2 subclavian, 2 innominate vein stenosis) and they all had a history of subclavian vein catheterization for hemodialysis. Seven patients presented with arm edema, one suffered from needling difficulty. Venography showed complete obstruction in 4 patients and severe stenosis in 4 patients. Angioplasty was attempted before stent placement but failed in all patients. The stent placement initially succeeded in all patients. There were no acute complications such as stent displacement, sepsis, and bleeding. After this intervention, clinical symptoms disappeared and all patients could be immediately treated with hemodialysis via corrected access. The patients were followed for 8.0±4.6 months (3-16 months). During this period, restenosis occurred in 2 patients. Of the 2 patients, one patient was successfully treated with angioplasty. In conclusion, endovascular stent placement seems to be effective on the treatment of proximal vein obstruction or stenosis irresponsive to angioplasty in hemodialysis patients.