臨牀透析 Vol.30 No.2(7-1)


特集名 バスキュラーアクセスの作製・管理・修復―標準化をふまえた個別化
題名 バスキュラーアクセス機能不全時の修復法 (1) PTA
発刊年月 2014年 02月
著者 土井 盛博 広島大学病院透析内科
【 要旨 】 長期透析患者や高齢患者,糖尿病患者の増加に伴い「外科的にバスキュラーアクセス(VA)再建の困難な患者」が増加し,「既存のVAを安易に再建することなく,VAとしての機能を可能なかぎり長期に維持する」という考え方が定着した結果,経皮的血管形成術(PTA)が広く施行されるようになった.PTAと外科的再建とは互いの欠点を補う治療法ではなく,PTAの施行が容易で開存率もよい前腕末梢の狭窄は,外科的治療も容易で開存率もよい.その一方,外科的治療が困難な上腕から中枢の狭窄は,PTAの開存率も低いことが特徴である.
Theme Vascular access -- Creation, management, repair : the individualization based on the standardization
Title Percutaneous transluminal angioplasty (PTA)
Author Shigehiro Doi Department of Blood Purification, Hiroshima University Hospital
[ Summary ] Stenosis is the most common complication observed in hemodialysis fistulas. It has traditionally been managed with surgery. However, percutaneous transluminal angioplasty (PTA) has been used frequently in recent years. The need for improvements in patency rates after PTA is a major issue. Patency rates after initial PTAs for arteriovenous fistula (AVF) are 74 % at 6 months and 67 % at 12 months, and those for arteriovenous grafts (AVG) are 53 % at 6 months and 26 % at 12 months. There is no significant difference between the first and second PTAs for both AVF and AVG, patency rates for AVG tend to decrease after two or more procedures. Since AVG leads to outflow vein stenosis within a short time after AVG creation and PTA for AVG exhibits low patency rates, we examined the usefulness of stent replacement on patency rates for AVG. As a result, stenting prolonged the patency rate only when the stent was replaced. In the case of restenosis after stent replacement, the patency rate was remarkably lower than that for stent replacement. In addition to stenosis at the outflow vein, in-graft stenosis is another issue associated with AVG. These results suggest that percutaneous management of dysfunctional AVG is often more difficult than that for AVF.
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