血液透析患者の内シャント側鎖骨下静脈閉塞症に対する1手術治験例 A CASE OF LEFT SUBCLAVIAN VEIN THROMBOSIS IN A HEMODIALYSIS PATIENT

この論文にアクセスする

この論文をさがす

著者

抄録

慢性血液透析患者で,左前腕に内シャントを造設後,左上肢の腫脹で発見された同側の鎖骨下静脈閉塞症に対する1手術例を報告する.症例は72歳女性で,糖尿病を基礎疾患に透析導入となり,左前腕に内シャントを造設後,約10カ月頃から,左上肢の腫脹が著明となり,静脈造影で左鎖骨下静脈の閉塞と著明な側副血行の発達を認めた.外傷や鎖骨下静脈へのカテーテル挿入の既往はない.原発性の鎖骨下静脈閉塞症と診断した.症状出現から1年後に,局所麻酔下に,リング付きE-PTFE人工血管を用いて,腋窩静脈-内頸静脈バイパス術を行った.術後症状は完全に消失し,静脈造影でグラフトの開存が確認された.しかし術後9カ月を過ぎて,再び同じ症状が出現し,静脈造影で内頸静脈との吻合部の狭窄を認めた.パッチによる吻合部拡張術を行い,左前腕の内シャントを閉鎖し,症状の消失をみた.透析患者のシャントトラブルの1つとして,注意すべき病態である.

We experienced an operated case of subclavian vein thrombosis on the same side as an existing arteriovenous (AV) fistula in a hemodialysis patient who had no history of venous catheterization.<br> A 72-year-old woman placed on maintenace hemodialysis for diabetic nephritis presented with marked edema and swelling of her arm and shoulder about 10 months after establishment of a left AV fistula. Venography demonstrated total occlusion of the left subclavian vein accompanied by marked development of collateral circulation. The patient was diagnosed as having primary deep venous thrombosis of the left upper extremity after detection of complete obstruction of the left subclavian vein without predisposing catheter cannulation. Left axillary-internal juglar vein bypass was performed with a ringed E-PTEF graft.<br> In post-operative course, her symptoms disappeared completely for several months. Graft patency was confirmed by postoperative venography. The patient complained of the same symptoms 9 months after the bypass procedure. Venography showed the stenotic change (about 50% stenosis) of the anastomosis between the graft and internal juglar vein. Reconstruction against a stenotic anastomosis by dilatation with E-PTFE patch was done in combination with an operation of closure of AV fistula on the left arm. This procedure promptly relieved the swelling of her left arm and the superficial collateral veins disappeared gradually.<br> We should call attention to the disease as a possible shunt trouble for the hemodialysis patient.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 56(6), 1249-1254, 1995-06-25

    Japan Surgical Association

参考文献:  20件中 1-20件 を表示

各種コード

  • NII論文ID(NAID)
    10008514111
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869776
  • データ提供元
    CJP書誌  J-STAGE 
ページトップへ