The Effect of Percutaneous Transluminal Angioplasty on Hemodialysis Shunt Insufficiency / 대한신장학회잡지

PURPOSE: The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty(PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. METHODS: Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier log- rank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated RESULTS: The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p > 0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. CONCLUSION: PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study.

Doppler Echocardiographic Study on the Changes of Cardiac Performance and Valvular Regurgitation before and after Hemodialysis

In 22 end-stage renal disease patients on regular hemodialysis, echocardiographic study including 2-D Doppler echocardiogrphy was performed to evaluate the effect of hemodialysis on cardiac performance and the degree of valvular regurgitation. After hemodialysis, there were significant improvement of ventricular contractility and reduction of circulating volume in accordance with the reduction of degree of valvular regurgitation in comparison with before hemodialysis. We postulate that the reduction of valvular regurgitation after hemodialysis is caused by relief of hypervolemic state.

A Case of Ventricular Septal Defect After Acute Myocardial Infarction

The rupture of ventricular septum complicating acute myocardial infarction requires prompt recognition for the correct management of the patient. The diagnosis of this condition had required right heart catheterization. We performed two-dimensional and Doppler echocardiography in patients with systolic murmur after acute myocardioal infarction. Ventricular septal defect was found at lower interventricular septum by mapping technique of pulsed wave Doppler system and obtained high velocity Doppler tracting by continuous wave Doppler echocardiography. Doppler echocardiography could be useful noninvasive method for detection of ventricular septal rupture after acute myocardial infarction.