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혈액투석 접근로 구제요법으로서의 약물방출 풍선카테터
황진호, 박상우
건국대학교 의학전문대학원 건국대학교병원 영상의학교실
Drug Coated Balloon for Vascular Access Salvage
Jin Ho Hwang, Sang Woo Park
Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
서 론
장기적인 투석로 확보를 위해서는 자가혈관 동정맥루(arterio
venous fistula, AVF) 혹은 인조혈관 동정맥루(arteriovenous graft, AVG)가 필요하다. 하지만 혈액투석로에 발생하는 협착은 투석로 기
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
않았으며 rated burst pressure (RBP)는 대부분 15 atm 이하이다. 투석
로 협착병변에 대해 DCB와 plain balloon의 device 성공률을 비교한
연구에서는 DCB의 성공률(45%)이 plain balloon (100%)에 비해 낮은
결과를 보였다(p<0.001) [13]. 따라서, DCB는 고압력 풍선을 사용했
을 때에 비해 anatomic success를 얻지 못하는 경우들이 많으며, 이에
대해 추가로 고압력 풍선의 도움을 받아야 하는 경우들이 생긴다는
것을 유념해야 한다.
결 론
현재까지 연구들을 보면 DCB는 conventional balloon에 비해 자가
혈관 및 인조혈관 혈액투석 동정맥루 협착증 및 중심정맥 협착증에
대한 혈관성형술 후 추적관찰 시 더 높은 개통률을 제공하는 것으로
보인다. 대규모 RCT나 장기간 추적관찰 연구 결과가 보고된다면 이
를 더 뒷받침할 수 있을 것으로 생각한다.
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A
B
Fig. 1. An example of PTA with drug-coated balloon for hemodialysis circuit stenosis. This 78 year-old female patient with a left forearm arteriovenous graft has history of stent placement in the left brachiocephalic vein. She had left arm edema and elevated venous pressure during hemodialysis. (A) No residual stenosis was noted after PTA with a 12 mm diameter balloon for severe focal stenosis at left brachiocephalic-subclavian vein junction. (B) Symptoms reemerged after 3 months, and PTA was performed for severe focal stenosis at the same location, with a 7 mm drug-coated balloon followed by a 12 mm plain balloon. Patient is symptom-free for 10 months.
황진호 외 : 혈액투석 접근로 구제요법으로서의 약물방출 풍선카테터 21
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