ABSTRACT
A 77-year-old woman with arteriovenous shunt for hemodialysis in the left forearm suffered from subarachnoid hemorrhage due to the rupture of a saccular aneurysm located on the left lateral wall of vertebrobasilar junction. Her left subclavian artery was severely stenosed and subclavian steal phenomenon was demonstrated on the digital subtraction angiography. Embolization of the parent artery including the aneurysm using detachable coils resulted in the successful obliteration of the aneurysm through the revascularized left subclavian artery. This is the first case in which the vertebrobasilar junction aneurysm would be caused by the hemodynamic stress due to the subclavian steal phenomenon combined with the shunt for hemodialysis in the left forearm.
Subject(s)
Aneurysm, Ruptured/complications , Intracranial Aneurysm/complications , Subclavian Steal Syndrome/etiology , Vertebral Artery , Aged , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/physiopathology , Aneurysm, Ruptured/therapy , Angiography, Digital Subtraction , Angioplasty, Balloon , Basilar Artery/diagnostic imaging , Basilar Artery/physiopathology , Cerebral Angiography/methods , Cerebrovascular Circulation , Computed Tomography Angiography , Embolization, Therapeutic , Fatal Outcome , Female , Hemodynamics , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/physiopathology , Intracranial Aneurysm/therapy , Subclavian Steal Syndrome/diagnostic imaging , Subclavian Steal Syndrome/physiopathology , Subclavian Steal Syndrome/therapy , Treatment Outcome , Vertebral Artery/diagnostic imaging , Vertebral Artery/physiopathologyABSTRACT
PURPOSE: To evaluate the usefulness of venous dialysis pressure(VDP) and urea recirculation rate(URR) for theearly detection of venous stenoses, the most common cause of hemodialysis fistular failure. To correlate theoutcome of early percutaneous transluminal angioplasty(PTA) with VDP and URR after PTA. MATERIALS AND METHODS: Eighty one chronic hemodialysis patients were monitored for VDP and URR during each session of hemodialysistreatment. Twenty-eight patients with elevated VDP and URR underwent fistulography, and the results wereprospectively analysed. PTA was performed in twelve discrete stenoses(>70% reduction of the lumen) in sixpatients. Following PTA, VDP and URR were reevaluated. RESULT: Fistulogramas showed that 15 of 28 patients had 22stenoses. All of these lesions occurred in the proximal vein of an arteriovenous fistula, showing less than 50%reduction of the lumen in six stenoses, 50-70% in four, more than 70% in twelve, and no complete occlusion.Stenosis length was less than 1cm in twelve lesions, 1-3cm in seven, and 3-6cm in three. In 11 of 12 stenoses,angioplasty was successful with no significant residual stenosis remaining. After PTA, mean VDP and URR fellsignificantly : 117.8+/-20.6 mmHg to 99.8+/- 8.2 mmHg (p=0.025), and 22.9+/-16.1 to 7.6+/-7.2(p=0.014), respectively. CONCLUSION: Early detection and early PTA of venous stenoses led to a high initial patency rate when used inconjuction with elective measurement of VDP and URR. After PTA, VDP and URR fell significantly, and there wasclose correlation with the outcome of PTA.
