内シャント狭窄のＰＴＡに際しｐａｒａｌｌｅｌ　ｗｉｒｅ　ｔｅｃｈｎｉｑｕｅが有用であった２症例

DOI 被引用文献4件 参考文献14件

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  • Parallel wire technique for the dilatation of stenotic hemodialysis fistula in 2 cases.

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Percutaneous transluminal angioplasty for stenosis of the hemodialysis fistula has rapidly become a wide spread method of maintaining vascular access. However, extremely rigid stenotic lesions around hemodialysis fistula are not often completely dilated by maximal balloon pressure. Such insufficient dilatation of the stenotic lesion may cause early restenosis and blood flow insufficiency. We describe two cases treated by the parallel wire technique for complete dilatation of a severely rigid stenotic lesion around a hemodialysis fistula. This technique has sometimes been used for percutaneous transluminal coronary angioplasty.<br>Case 1: A 64-year-old man was examined because of decreased vascular sound in the hemodialysis fistula. Angiography of the hemodialysis fistula revealed a 73% diameter stenosis. This lesion was incompletely dilatated at 12 atmospheres (atms.) of the balloon, which was rated burst pressure and the balloon showed indentation. Thereafter, we tried the parallel wire technique to treat this rigid lesion. After parallel bare wires were inserted using a sheath balloon angioplasty was performed again at 12 atms. The rigid stenotic lesion was dilated successfully by this technique.<br>Case 2: A 68-year-old man presented with decreasing blood flow (<120ml/min.) through the hemodialysis fistula. Angiography revealed a 85% stenosis in a long segment of the fistula. As in case 1, the stenotic lesion was not dilated completely at 12 atms. of balloon burst pressure, but was dilated successfully at 10 atms. by the parallel wire technique. After these procedures, there has been no sign of restenosis in the dilated portions and there is sufficient blood flow through the fistula in both cases. This technique for treating rigid stenosis of hemodialysis fistula is useful and may be able to reduced the incidence of restenosis after percutaneous transluminal angioplasty.

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