Horita Yuki, Namura Masanobu, Matsumura Masami
Department of Cardiology, Kanazawa Cardiovascular Hospital, Tanakamachi, Kanazawa City, 920-0007, Japan.
Catheter Cardiovasc Interv. 2006 Jun;67(6):961-6. doi: 10.1002/ccd.20736.
If a large amount of debris or thrombus dislodges from a lesion because of dilation of the stenotic or occluded lesion in the hemodialysis access fistula when angioplasty is performed, it may move into the pulmonary artery via the central vein, resulting in pulmonary embolism. A novel sheath has been developed to prevent the outflow of debris or thrombus to the central vein. The catheter consists of a 5 F sheath introducer and a silicone balloon attached at the tip of the sheath. The silicon balloon is inflated via small inflation lumen on the shaft wall of the sheath. In the case of percutaneous transluminal angioplasty (PTA), the silicone balloon is inflated to block the blood flow by a mixture of contrast medium and physiological saline, and then dilate a stenotic or occluded lesion by PTA balloon. Next, the debris and thrombus are aspirated using the flush-lumen of this device. Finally, the silicone balloon is deflated and the dilation of the lesion is confirmed. A case of hemodialysis access fistula graft with massive thrombotic occlusion was presented. This device enabled Fogarty procedure using PTA balloon and the blood flow of the graft was completely improved and a large amount of thrombus was removed. This novel device is useful to prevent the embolic complication of the intervention for hemodialysis access fistula.
如果在进行血管成形术时，由于血液透析通路瘘管中狭窄或闭塞病变的扩张，大量碎片或血栓从病变处脱落，它可能会通过中心静脉进入肺动脉，导致肺栓塞。一种新型鞘管已被开发出来，以防止碎片或血栓流向中心静脉。该导管由一个5F鞘管导入器和一个附着在鞘管尖端的硅胶球囊组成。硅胶球囊通过鞘管轴壁上的小充气腔进行充气。在经皮腔内血管成形术（PTA）中，硅胶球囊充气，通过造影剂和生理盐水的混合物阻断血流，然后用PTA球囊扩张狭窄或闭塞病变。接下来，使用该装置的冲洗腔抽吸碎片和血栓。最后，硅胶球囊放气并确认病变扩张情况。本文介绍了一例血液透析通路瘘管移植物出现大量血栓闭塞的病例。该装置能够使用PTA球囊进行Fogarty手术，移植物的血流得到完全改善，大量血栓被清除。这种新型装置有助于预防血液透析通路瘘管介入治疗的栓塞并发症。
