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기능부전 터널식 투석용 도관의 교체 시 시행한 정맥조영술 결과의 분석과 혈관 내 치료 기술의 결과

Assessment of venographic abnormalities during replacement of dysfunctional tunneled hemodialysis catheters and outcome of endovascular salvage techniques

  • 박선영 (Seon Young Park, 일반대학원)

초록/요약

Objectives: To assess the venography findings of central venous abnormalities before exchanging dysfunctional tunneled hemodialysis catheters and also to assess the outcome of endovascular salvage techniques. Materials and Methods: From January 2011 to December 2015, seventy-eight patients (M:F, 33:45; mean age: 67 y; age range: 25-86 years) undergoing catheter-directed hemodialysis treatment were evaluated for 110 episodes of tunneled hemodialysis catheter dysfunction. Venography was performed through indwelling hemodialysis catheter pulled out to brachiocephalic vein before catheter exchange, and subsequent procedure was taken according to the venography findings - catheter exchange with or without tip position adjustment, balloon disruption of fibrin sheath, or angioplasty of venous stenosis or occlusion. Immediate evaluation of catheter function was manually performed at the intervention room after catheter exchange and technical success was defined as at least one successful session of hemodialysis with the exchanged catheter. Patients were followed up to the end-points or to the point of last hospital visit with evaluation of procedure associated complications such as catheter-related infection. Results: Venography findings showed abnormalities in 67 out of 110 exchanged catheters; central vein stenosis in 27 (40.3%), fibrin sheath formation in 17 (25.4%), thrombus formation in 12 (17.9%), complex findings of more than two abnormalities in 9 (13.4%), and two cases of in-stent restenosis. Among sixty-seven abnormal venography cases, 34 catheters were exchanged with or without catheter tip position adjustment. Balloon disruption of fibrin sheath was performed in 9 cases and balloon angioplasty of central vein stenosis or occlusion was performed in 20 cases. Balloon was used for both fibrin sheath disruption and central venous angioplasty in 1 complex case and endovascular stent was placed in 3 complex cases according to the indication. Manually assessed immediate catheter function was good in all cases and technical success was confirmed in all cases. During follow up, 29 catheters were lost to follow-up and the estimated 30-day catheter patency for all of the assessable catheters was 61.7%. Among assessable catheters showing abnormal venography findings, estimated 30-day catheter patency was 60.7% for catheter exchange with or without catheter tip position adjustment, 75% for balloon disruption of fibrin sheath, and 70% for balloon angioplasty of central vein stenosis or occlusion. Nine catheters were removed during the follow-up period due to suspected catheter-related infection, which was equivalent to 1.1 episodes/1000 catheter days. There were no other complications associated with the procedure. Thirteen patients revisited the intervention room due to 32 episodes of recurrent dysfunction of hemodialysis catheter, with most common reason being central vein stenosis, followed by complex cases of more than one abnormal venography findings. Conclusion: About 60% of dysfunctional tunneled hemodialysis catheter showed abnormal venography findings, with central venous stenosis being the most common abnormality. Appropriate endovascular techniques were performed according to the venography findings and the catheter patency was comparable with previous reports regarding various techniques for the management of dysfunctional hemodialysis catheter, with low risk of procedure related complications.

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ABSTRACT
TABLE OF CONTENTS
LIST OF FIGURES
LIST OF TABLES
I. INTRODUCTION
II. MATERIALS AND METHODS
A. Patients
B. Techniques
C. Follow-up
III. RESULTS
IV. DISCUSSION
V. CONCLUSION
REFERENCES
국문요약

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