Park Yoon Soo, Yang Seung Boo, Kang Chae Hoon, Goo Dong Erk
J Korean Soc Radiol. 2024 Jul;85(4):746-753. doi: 10.3348/jksr.2023.0121. Epub 2024 Jan 15.
This study aims to evaluate the incidence and management of venous ruptures after percutaneous transluminal angioplasty (PTA) for dysfunctional arteriovenous (AV) access.
From January 1998 to December 2015, 13506 PTA, mechanical thrombectomy, and thrombolysis procedures were performed in 6732 patients. The venous rupture rate following PTA was obtained, and access circuit primary patency (ACPP) was compared according to the etiology (PTA, thrombotic occlusion, and treatment type) of the venous rupture present.
Venous rupture developed in 604 of the 13506 procedures. Venous ruptures were more frequent in female, AV graft cases, and in cases accompanied by thrombosis. Balloon tamponade was performed in 604 rupture cases, and stents were deployed in 119 cases where contrast extravasation and flow stasis persisted. ACPP was significantly better in the non-ruptured AV access circuits than in the ruptured group. However, AV access type and thrombosis was not associated with primary patency. In ruptured cases, ACPP is 8.4 months for prolonged balloon tamponade and 11.2 months for bare-metal stent insertion, showing statistically significant difference.
Balloon tamponade and bare-metal stent placement are effective treatment for PTA-induced venous ruptures. In particular, stent placement showed a similar ACPP to that of non-ruptured AV access circuits.
本研究旨在评估经皮腔内血管成形术（PTA）治疗功能不良的动静脉（AV）通路后静脉破裂的发生率及处理方法。
1998年1月至2015年12月，对6732例患者进行了13506次PTA、机械性血栓清除术和溶栓术。得出PTA后静脉破裂率，并根据存在的静脉破裂病因（PTA、血栓闭塞和治疗类型）比较通路循环的初始通畅率（ACPP）。
13506例手术中有604例发生静脉破裂。静脉破裂在女性、AV移植物病例以及伴有血栓形成的病例中更为常见。604例破裂病例进行了球囊压迫，119例造影剂外渗和血流淤滞持续存在的病例植入了支架。未破裂的AV通路循环的ACPP明显优于破裂组。然而，AV通路类型和血栓形成与初始通畅率无关。在破裂病例中，延长球囊压迫的ACPP为8.4个月，裸金属支架置入的ACPP为11.2个月，差异有统计学意义。
球囊压迫和裸金属支架置入是治疗PTA引起的静脉破裂的有效方法。特别是，支架置入的ACPP与未破裂的AV通路循环相似。
