반복적인 투침으로 인해 인조혈관과 자가 정맥 사이에 발생한 의인성 동정맥루 환자들에서의 임상적 특징

다국어 초록 (Multilingual Abstract)

Purpose: Failure of hemodialysis access is the main medical problem in chronic renal failure patients. This resulted from complications such as thrombosis, infection, pseudoaneurysm, steal syndrome and so on. This study was undertaken in an attempt to describe the clinical characteristics and significances of dialysis failure due to iatrogenic fistula between prosthetic graft and native vein at puncture site.
Methods: During 5 years between Feb. 2005 and Feb. 2009, five Iatrogenic fistulas were identified in a retrospective review of 133 patients performed 220 times fistulography due to dialysis failure in PTFE (polytetrafluoroethylene) graft.
Results: Overall incidence is 3.8 % in PTFE graft cases. Mean age is 50 (28~75) years, male to female ratio 2：3. Median 1st patency period is 20 months (6~36). All iatrogenic fistula is usually located in not venous but arterial limb of forearm loop, combined with the stenosis in venous limb and anastomosis site. More than 70% venous anastmotic stenosis in 4 cases (80%) and diffuse stenosis of venous limb in 3 cases (60%), revised concomitantly either by patch angioplasty or ballooning. Medial follow-up period is 8 months (5~12), graft occlusion occurred in one case.
Conclusion: All iatrogenic fistula usually occurs in not venous but arterial limb of forearm loop graft. Most iatrogenic fistula is combined with the stenosis in venous limb and anastomosis sites, must be revised concomitantly either by patch angioplasty or ballooning. Close assessment to superficial vein and graft is needed for early detection. Fistulography is the most useful diagnostic tool. Careful cannulation method is required to prevent the occurrence of iatrogenic fistula in chronic renal failure patients.

목차 (Table of Contents)

• 서론
• 방법
• 결과
• 고찰
• REFERENCES

참고문헌 (Reference)

1 III, "NKF-K/DOQI clinical practice guidelines for vascular access: update 2000" 37 : S137-181, 2001

2 Min SK, "Iatrogenic fistula between prosthetic haemodialysis access graft and autogenous vein: unusual cause of graft thrombosis" 19 : 2647-2649, 2004

3 Wilson SE, "Complications of vascular access procedures. In Vascular Access: Principles and Practice. 3rd ed." Mosby 189-203, 1996

4 You YK, "Clinical experience of PTEF (polytetrafluoroethylene) graft A-V fistula for hemodialysis of chronic renal failure patient" 41 : 345-351, 1991

5 Davidson IJA, "Access for Dialysis: Surgical and Radiologic Procedures. 2nd ed" Landes Bioscience 2002