| 特集名 | バスキュラーアクセスをめぐる最近の話題 | |
|---|---|---|
| 題名 | 人工血管内シャント (AVG) (2) AVG開存率の向上をめざして | |
| 発刊年月 | 2005年 11月 | |
| 著者 | 鵜川 豊世武 | 香川大学医学部第二内科学講座アクセス血管外科 |
| 【 要旨 】 | expanded polytetrafluoroethylene (ePTFE) arteriovenous vascular access graft (AVG) の二次開存率を向上させるため，percutaneous transluminal angioplasty (PTA) 治療を考慮した人工血管移植術を行い，4年半が経過して106症例を経験した．HIT (heparin induced thrombosis)，感染，スティール症候群による4症例を失った以外は二次開存を認め，3年累積開存率は95.9％であった．AVG閉塞の原因は，おもにグラフト-静脈側狭窄で，同部位にPTAを行うことで二次開存を保った．術後PTA治療を効果的に，かつ容易に施行できる血管を選択するために，術前digital subtraction angiography (DSA) でinflow arteryとoutflow veinを決定して手術を施行した．outflowに上腕basilic veinを選択したことと，AVGの管理基準を設定したことが術後管理を容易にした． | |
| Theme | Current Topics in Hemodialysis Vascular Access | |
|---|---|---|
| Title | Patency of expanded polytetrafluoroethylene arteriovenous vascular access grafts (AVGs) -- Collaboration of interventional therapy | |
| Author | Toyomu Ugawa | Division of Vascular Access Surgery, Second Department of Internal Medicine, Faculty of Medicine, Kagawa University |
| [ Summary ] | To assess whether an interventional therapy protocol that includes preimplantation identification of inflow and outflow vessels with the use of digital subtraction angiography (DSA) and early postoperative percutaneous transluminal angioplasty (PTA) and if treatment would improve secondary patency rates for expanded polytetrafluoroethylene (ePTFE) vascular access grafts in patients undergoing long-term hemodialysis. Patency data were obtained from the records of 106 patients who underwent synthetic bridge graft implantation and PTA, according to the protocol, over the past 4.5 years. Data were analyzed by using the Kaplan-Meier life-table method, as well as other assessments. In 89 of 106 patients, the patency of stenosed access grafts was restored by using PTA. 102 patients achieved secondary graft patency. In the other 4 patients, restoration of patency was not possible because of heparin-induced thrombosis, infection, or steal syndrome. Using the Kaplan-Meier analysis, the 3-year cumulative patency rate in the series was 95.9 %. Patients who underwent graft implantation or endografting in the same arm as the faild access generally had less need for PTA over time. Interventional therapy to treat stenoses effectively maintains the secondary patency of ePTFE vascular access grafts. DSA is useful for preoperative identification of the inflow artery and the outflow vein that will allow optimal PTA. Use of the basilic vein in the upper arm for the outflow vessel facilitates postoperative management of vascular access. |
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