維持透析患者の虚血性末梢循環障害についての臨床的検討

DOI 被引用文献4件
  • 阿岸 鉄三
    東京女子医科大学腎臓病総合医療センター外科
  • 春口 洋昭
    東京女子医科大学腎臓病総合医療センター外科
  • 北島 久視子
    東京女子医科大学腎臓病総合医療センター外科
  • 佐藤 純彦
    東京女子医科大学腎臓病総合医療センター外科
  • 太田 和夫
    東京女子医科大学腎臓病総合医療センター外科

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タイトル別名
  • Clinical assessment of ischemic peripheral circulatory disorders in maintenance hemodialysis patients.

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Ischemic peripheral circulatory disorders have been observed more and more frequently in maintenance hemodialysis patients in recent years. This tendency coincides with the increasing progression of arteriosclerosis in maintenance hemodialysis patients. Clinical investigations were therefore presumed to be useful in elucidating the pathogenesis of the symptoms. Among 20 patients diagnosed with ischemic peripheral circulatory disorders, arteriosclerotic obstruction (ASO) was diagnosed in 12 patients and the steal syndrome (SS) in 11 patients. Three patients had both.<br>Suspected risk factors were as follows: sex, male vs female=11/9; age>65 years old, 7/20; chronic renal failure, 20/20; dyslipidemia, 6/20; diabetes mellitus, 7/20; double/triple internal shunt, 4/20, accelerated coagulability, 8/8; accelerated fibrinolysis, 4/7.<br>Symptom severity was graded according to Fontaine's classification, and the results were as follows: in ASO patients, grade I: 1 patients, grade II: 5, grade III: 2, grade IV: 4, and tentatively applying the same classification to the SS patients, grade I: 1, patient grade II: 3, grade III: 7, and grade IV: 0.<br>SS was suspected of more readily developing after creation of the internal shunt in patients who already had arteriosclerosis in arteries distal to the fistula.<br>Examinations useful in reaching a diagnosis were ankle pressure index, thermography, plethysmography, angiography and magnetic resonance imaging. Digital subtraction angiography is indicated in diagnosing SS in which a natural blood flow pattern is ascertained.

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