Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Clinical Efficacy of the Transradial Approach in Percutaneous Intervention for a Malfunctioning Arteriovenous Fistula

혈액 투석 동정맥루의 기능 부전에 대한 인터벤션 치료 시 경요골 동맥 접근법의 유용성

  • Hyun Young Choi (Department of Radiology, Kosin University College of Medicine) ;
  • Gyoo-Sik Jung (Department of Radiology, Ulsan Medical Center) ;
  • Hee Kang (Department of Radiology, Kosin University College of Medicine) ;
  • Ye Na Kim (Department of Internal Medicine, Kosin University College of Medicine) ;
  • Hyung Hwan Moon (Department of General Surgery, Kosin University College of Medicine) ;
  • Jong Hyouk Yun (Department of Radiology, Kosin University College of Medicine)
  • 최현영 (고신대학교 의과대학 영상의학과) ;
  • 정규식 (울산병원 영상의학과) ;
  • 강희 (고신대학교 의과대학 영상의학과) ;
  • 김예나 (고신대학교 의과대학 내과) ;
  • 문형환 (고신대학교 의과대학 외과) ;
  • 윤종혁 (고신대학교 의과대학 영상의학과)
  • Received : 2021.05.12
  • Accepted : 2021.07.09
  • Published : 2022.05.01
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Abstract

Purpose To evaluate the effectiveness of the transradial artery approach (TRA) for treating malfunctioning arteriovenous fistulas (AVFs) in patients on hemodialysis. Materials and Methods A retrospective analysis was conducted in this single-center study of TRA endovascular procedures in 73 patients (43 male and 30 female; mean age of 67.4 years (range, 42-92 years) with malfunctioning AVFs, between January 2008 and April 2019. Patients' baseline and lesion characteristics, technical and clinical success, and complications were evaluated, and functional patency was analyzed using the Kaplan-Meier method. Results Radial artery approaches were successful in all patients. Angioplasty performed using the TRA achieved technical and clinical success rates of 98.6%(72/73) and 91.7%(67/73), respectively. The median primary patency time was 18.8 ± 15.9 months. The primary functional patency rates at 3, 6, and 12 months were 82.1%, 68.6%, and 63.9%, respectively. There were no major complications or adverse events, such as hand ischemia, related to the radial artery approach. Conclusion In selected cases, the TRA can be used complementary to the transvenous approach to treat malfunctioning AVFs.

목적 혈액투석경로의 기능부전에 대한 인터벤션 치료 시 경요골 동맥 접근법의 유용성을 연구하고자 한다. 대상과 방법 2008년 1월부터 2019년 4월까지 73명의 환자에서(남성 43명, 여성 30명, 평균 연령 67.4세; 범위 42-92세) 경요골 동맥 접근법을 이용한 시술을 시행한 환자들에 대해 후향적 연구를 시행하였다. 환자들의 기본적인 특성과 병변의 특성, 경요골 동맥 접근을 통한 인터벤션 시술의 기술적 및 임상적 성공률, 시술과 연관된 합병증에 대해 조사하였고 장기 개통성에 대해서는 카플란-마이어 방법을 이용하여 분석하였다. 결과 모든 환자에서 요골 동맥을 통한 혈관조영술을 성공적으로 시행하였고, 기술적 성공률은 98.6%(72/73), 임상적 성공률은 91.7%(67/73)였다. 일차적 개통률의 중앙값은 18.8 ± 15.9개월이었고, 3, 6, 12개월 누적 개통률은 각각 82.1%, 68.6%, 그리고 63.9%였다. 모든 환자에서 손의 허혈과 같은 주요한 합병증은 발생하지 않았으며 경요골 동맥 천자와 연관한 즉각적인 합병증 또한 발생하지 않았다. 결론 혈액투석경로 기능 부전 환자에서 경요골 동맥 접근법을 통한 인터벤션 시술은 안전하고 임상적으로 유용한 방법으로 생각된다. 또한 선별된 환자에서 전통적인 경정맥 접근법에 대해 대안으로 기능할 수 있을 것으로 생각된다.

Keywords

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