内シャント高度狭窄症例に対する自己反転式パラレルワイヤーテクニックの有用性

DOI 被引用文献3件 参考文献12件

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  • An efficient technique for dilatation of A-V fistula stenosis. Self-reversed parallel wire technique.

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In hemodialysis (HD), a major issue in achieving stabilized maintenance of HD is maintenance of the internal shunt for blood access. However, in clinically practice stenosis or occlusion may occur even when carefully managed, due to vascular injury associated with vascular avulsion at the time of surgery, non-physiologic vascular flow load or mechanical damage by puncture. To treat this event, blood access intervention therapy (BAIVT) for the internal shunt has come into wide use recently with the development of various devices. However, experience has shown that use of the high pressure-resistant balloon catheter sometimes leads to balloon indentation and insufficient dilatation. For patients with severe fibrous stenosis, we have performed the parallel wire technique (PWT) with some modification. As a guide wire, RadifocusTM (TERUMO CO., Ltd.) was used. For the PWT, two wires normally need to be inserted, the wire which is used for guiding the catheter should be self-reversed and placed outside the balloon to be dilated. Therefore, a sheath other than the one applied for the balloon is not required, and the procedure can be carried out without blood loss. To perform PWT more simply, we have devised and currently use a 5cm trial product with a supple tip length of 3cm as a modification of the normal product. This product allows insertion of a longer loop portion of the reversed wire compared to the balloon size. Thus, PWT is possible without any preparing any special equipment or material. This method is easy to perform and allows efficient dilatation of the balloon indentation in severe fibrous stenosis, which persists even when the a high pressure-resistant balloon is used. Therefore, this may be a useful procedure when there is difficulty in dilatation.

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