Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, 7-1 Funabashi, Wadanaka-cho, Fukui, 918-8503, Japan,
Jpn J Radiol. 2014 Feb;32(2):117-22. doi: 10.1007/s11604-013-0277-6. Epub 2014 Jan 8.
To report the usefulness of percutaneous transluminal angioplasty (PTA) of a non-mainstream venous route in an occluded native hemodialysis fistula when a mainstream outflow vein could not be traversed.
This cohort included seven patients with an occulted hemodialysis fistula with difficulty in traversing via a mainstream route. A non-mainstream vein near the occluded portion was traversed until it connected with a proximal large-sized vein and the route was dilated using a 4- or 5-mm balloon catheter. Metallic stent placement was performed, if necessary. Technical aspects and long-term patency was evaluated.
PTA could be performed in all patients; however, stent placement was required in two because of residual stenosis and clotting. The clinical success rate of fistula restoration was 100 %. Fistula dysfunction recurred in six patients 17-668 days (mean ± standard deviation 229.3 ± 225.0) later. PTA was repeated in four patients, but not in two. The mean duration of the primary patency was 336.6 ± 417.2 days (range 17-1,190) and that of the secondary patency was 897.1 ± 801.4 days (range 17-2,230).
PTA of a non-mainstream venous route is useful for restoring an occluded hemodialysis fistula when the mainstream outflow vein cannot be traversed.
报告在主流流出静脉无法通过时，经皮腔内血管成形术（PTA）治疗闭塞性原生血液透析瘘管的非主流静脉途径的有效性。
本队列纳入了 7 例经主流途径难以通过的隐匿性血液透析瘘管患者。穿过闭塞部位附近的非主流静脉，直到与近端大静脉连接，并使用 4 或 5mm 的球囊导管扩张该通路。如果需要，可进行金属支架置入。评估技术方面和长期通畅性。
所有患者均能进行 PTA；但由于残余狭窄和血栓形成，有 2 例需要支架置入。瘘管恢复的临床成功率为 100%。6 例患者在 17-668 天（平均 ± 标准差 229.3 ± 225.0）后出现瘘管功能障碍复发。4 例患者重复进行了 PTA，但 2 例患者未重复。初次通畅的平均持续时间为 336.6 ± 417.2 天（范围 17-1190），二次通畅的平均持续时间为 897.1 ± 801.4 天（范围 17-2230）。
当主流流出静脉无法通过时，经非主流静脉途径的 PTA 对于恢复闭塞性血液透析瘘管是有用的。
