Park Sung Il, Kim Il Jung, Lee Shin Jae, Kim Man Deuk, Won Jong Yun, Lee Do Yun, Kang Shin-Wook, Choi Kyu Hun
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea,
Cardiovasc Intervent Radiol. 2014 Apr;37(2):502-7. doi: 10.1007/s00270-014-0847-8. Epub 2014 Feb 6.
This study was designed to evaluate the feasibility of balloon catheter looping technique for angioplasty of entry site lesions of stenosis or thrombi that could not be aspirated during endovascular treatment of thrombosed arteriovenous grafts by single access.
Balloon catheter looping technique was used for angioplasty of entry site lesions in 13 sessions of treatment of thrombosed arteriovenous grafts by single access in 11 patients (M:F = 7:4, mean age: 70.7 years, 9 brachio-axillary straight and 2 brachio-antecubital loop grafts) and were retrospectively evaluated. Middle equator of the graft was punctured and a 7F Desilets-Hoffman introducer sheath was inserted for aspiration thrombectomy and angioplasty. For entry site angioplasty, the balloon catheter was positioned 4-5 cm beyond the tip of the sheath. The sheath was retrieved to the entry site and was redirected into the contralateral limb, so the balloon catheter would form a loop. The introducer sheath was advanced to pull the balloon back to cover the entry site for angioplasty. Radiological images and medical records were evaluated for feasibility, success rate, and complications.
Technical success of treatment of thrombosed graft and balloon catheter looping for entry site angioplasty could be achieved in all 13 cases (100%), without requiring second access. Completion fistulography revealed no access complication. Patency rate at 3 and 6 months were 80 and 68.6%, respectively.
Balloon catheter looping technique for angioplasty of entry site lesions during endovascular treatment of thrombosed arteriovenous graft is a feasible alternative technique to obtaining a second access.
本研究旨在评估球囊导管成环技术用于血管腔内治疗血栓形成的动静脉移植物时，对无法通过单次穿刺抽吸的狭窄或血栓形成的穿刺部位病变进行血管成形术的可行性。
对11例患者（男∶女 = 7∶4，平均年龄70.7岁，9例为肱-腋直形移植物，2例为肱-肘前襻状移植物）进行了13次单次穿刺治疗血栓形成的动静脉移植物，采用球囊导管成环技术对穿刺部位病变进行血管成形术，并进行回顾性评估。穿刺移植物的中间赤道部位，插入一个7F的德西莱特-霍夫曼导入鞘进行血栓抽吸和血管成形术。对于穿刺部位血管成形术，将球囊导管放置在鞘尖端以外4-5厘米处。将鞘拉回到穿刺部位并重新导向对侧肢体，使球囊导管形成一个环。推进导入鞘以将球囊拉回以覆盖穿刺部位进行血管成形术。对放射影像和病历进行可行性、成功率及并发症评估。
所有13例（100%）均成功实现了血栓形成移植物的治疗及球囊导管成环用于穿刺部位血管成形术，无需二次穿刺。完成的瘘管造影显示无穿刺并发症。3个月和6个月时的通畅率分别为80%和68.6%。
在血管腔内治疗血栓形成的动静脉移植物时，球囊导管成环技术用于穿刺部位病变的血管成形术是一种可行的替代二次穿刺的技术。
