Application of Cutting Balloon Angioplasty for Undilatable Venous Stenoses Causing Dialysis Access Dysfunction

對長期依賴透析治療來維持正常生命的慢性洗腎患者而言，擁有良好順暢的瘻管是最基本的需求，很不幸的，瘻管狹窄阻塞卻是極為常見的問題，造成瘻管功能不良、透析治療效果不全和最終引起血栓致瘻管完全阻塞的情形，經皮氣球擴張術是目前最常使用的治療方法，可有效的延長瘻管的使用壽命，然而傳統氣球擴張術治療，有兩個常見的難題極待克服，一是治療過後近期仍有很高的再狹窄率，二是少數病灶非常硬化，即使使用很高壓力的氣球擴張仍無法撐開狹窄病灶，這些病患往往需要進一步接受外科手術，重建新的瘻管，因此發展新的技術工具刻不容緩。自2005年4月至7日，本院發現有五位這類患者，其中四位進一步接受了切割氣球擴張術治療，結果效果顯著，所有無法用傳統高壓氣球擴張的病灶都輕而易舉的擴張，恢復正常血管管徑，上述經驗顯示切割氣球值得成為洗腎瘻管狹窄治療上不可獲缺的補助工具，針對無法用傳統氣球擴張的病灶，選擇性的使用切割氣球能夠拯救及延長瘻管的壽命。

關鍵字

洗腎瘻管狹窄；切割氣球

並列摘要

Adequate vascular access is a fundamental requirement to keep alive patients on regular hemodialysis. Unfortunately, one of the major problems encountered in long-term hemodialysis is vascular access stenosis, leading to poor dialysis and ultimately resulting in thrombosis. Percutaneous transluminal angioplasty (PTA) for failing vascular access significantly prolongs the life of access. However, two major problems have not been solved in conventional high pressure balloon angioplasty. One is a strong tendency of reobstruction within a short time; the other problem is balloon-resistant stenosis, which represents the major cause of technical failure and inevitably requires surgical intervention. Development of new device is necessary to overcome such problems. From April to July 2005, we identified 5 cases with severe undilatable lesions, accounting for about 3% of our treatment patients. Four of them were treated by cutting balloon with excellent angiographic results without complication or difficulty, successfully salvaging the dialysis access. Cutting balloon angioplasty should be an essential adjunct treatment modality for those patients with undilatable lesions.

並列關鍵字

Hemodialysis fistula stenosis ； Cutting balloon

國際替代計量

Application of Cutting Balloon Angioplasty for Undilatable Venous Stenoses Causing Dialysis Access Dysfunction

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