2005 Volume 38 Issue 2 Pages 105-110
Blood access problems are one of the most common complications in the management of hemodialysis patients. We performed arteriovenous fistula angiography in 318 cases between January 1997 and April 2002 to determine an appropriate therapeutic strategy. The reasons for angiography examination were insufficient blood flow (131 cases, 41.2%) and high venous pressure (44 cases, 13.8%). As a result, 318 cases showed 380 abnormal findings in the vein adjacent to the anastomosis (230 regions 60.5%), in the arteriovenous anastomosis (67 regions, 17.6%), in the artificial vessel (50 regions, 13.2%), in the central portion of vein (24 regions, 6.3%), and in the artery (4 regions, 1.1%). Overall, 263 regions (69.2%) exhibited stenoses in arteriovenous fistulae. We performed surgery in 132 patients including shunt reconstruction (82 cases, 25.9%) for arteriovenous anastomosis problems, new blood access (31 cases, 9.7%) or graft transplantation (19 cases, 6.0%) for problems in the central portion of the vein. We chose intervention therapy such as percutaneous transluminal angioplasty (PTA) for 79 cases (24.8%) comprising nearly half of the cases showing problems in the vein adjacent to the anastomosis. Since some blood access trouble exhibited multiple abnormal findings, comprehensive angiography from the anastomosis to the central portion of vein is necessary to reduce the number of additional surgeries required. It is also preferable that possible reconstruction surgery be performed on existing blood access. In multiple surgery patients and graft recipients, interventional procedures should be considered. These results suggest that angiography is helpful for determining the optimal therapeutic strategy for blood access problems.
