Original Article pissn J Korean Soc Radiol 2013;68(3): The Impact of Anastomotic Angle for Re-Occlusion of Brachioaxillary Graft Arte

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1 Original Article pissn J Korean Soc Radiol 2013;68(3): The Impact of Anastomotic Angle for Re-Occlusion of Brachioaxillary Graft Arteriovenous Fistula after Percutaneous Thromboaspiration 1 위팔동맥 - 겨드랑정맥인조혈관동정맥루의폐색시경피적혈전흡입술후문합각이재협착에미치는영향 1 Keon Young Kim, MD 1, Gong Yong Jin, MD 1,2, Seung Bae Hwang, MD 1,2, Eun Jung Choi, MD 1, Ji Soo Song, MD 1, Young Min Han, MD 1,2,3, Keun Sang Kwon, MD 4 1 Department of Radiology, 2 Institute of Medical Science, 3 Institute of Cardiovascular Research, 4 Preventive Medicine, Chonbuk National University Hospital and Medical School, Jeonju, Korea Purpose: The purpose of this study is to evaluate the factors that affect graft patency in brachioaxillary graft arteriovenous fistula patients. Materials and Methods: A retrospective study was conducted on 33 patients (20 men, 13 women; mean age, 67.5 years; mean interval to first stenosis, 17 months), who had performed percutaneous angioplasty for first episode of stenosis after brachioaxillary graft surgery. We evaluated the relevant factors affecting the graft patency after first episode of stenosis, such as age, sex, underlying disease (hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, cerebrovascular attack), anastomotic angle between graft and axillary vein, and anastomotic angle between the graft and brachial artery. Kaplan-Meier method and log rank test and receiver operating characteristics curve analysis were used in statistical analysis. Results: Graft patency rates after 1 month, 6 months, and 12 months were 75.8%, 39.4%, and 9.1%. There was a correlation between graft-axillary vein anastomotic angle and patency rates (r = 0.372, p = 0.033); larger the venous anastomotic angle, the longer patency rate. However, it does not come up with significant results in patency rates on age, sex, underlying disease, and graft-brachial artery angle. Conclusion: In patients with brachioaxillary graft arteriovenous fistula, as venous anastomotic angle more obtuse, the graft patency may be longer. Index terms Arteriovenous Fistula Percutaneous Transluminal Angioplasty Vascular Patency Thrombectomy Surgical Anastomosis Received November 16, 2012; Accepted December 14, 2012 Corresponding author: Young Min Han, MD Department of Radiology, Institute of Medical Science, Institute of Cardiovascular Research, Chonbuk National University Hospital and Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju , Korea. Tel Fax Copyrights 2013 The Korean Society of Radiology 서론 혈액투석환자의동정맥루기능을유지하는것은환자의생존에매우중요하다. 자가혈관동정맥루를이용한투석이권장되지만, 장기적인투석을받는환자가늘어나면서인조혈관을사용하는경우가점차늘어나고있다 (1). 위팔동맥 (brachial artery) 과액와정맥 (axillary vein) 을연결하여삽입하는인조동정맥루는자가혈관을이용할수없을경우흔히사용하는방법으로, 인조혈관을자가혈관에단측 (end-to-side) 문합으로연결하므로문합되는부위는 T형을띠게된다. 동정맥루의협착은주로이러한문합부, 특히정맥문합부에 서주로발생하며이로인한정맥압의증가는가장흔한임상소견이다 (2). 협착은미숙한수술능력, 문합부가너무좁아서필요한혈류량을유지하지못할경우, 혈관의꼬임이나반복된혈관천자로인해서발생할수있다 (3). Wedgwood 등 (4) 은동정맥루의폐색은수술방법에따라영향을받을수있다고하였으며자가혈관을이용한동정맥루형성에서는단측문합술 (endto-side anastomosis) 이측측문합술 (side-to-side anastomosis) 에비해서좋은예후를보였다고보고하였다. 이외에도혈관의상태가폐색의원인으로작용할수있는데, 혈관의작은구경이나동맥경화증, 내막과형성등이혈류흐름에영향을주어폐색에영향을미치는것으로보고된바있 submit.radiology.or.kr 대한영상의학회지 2013;68(3):

2 위팔동맥 - 겨드랑정맥인조혈관동정맥루의폐색시경피적혈전흡입술후문합각이재협착에미치는영향 다. 이러한혈류흐름의변화는저항지수 (resistive index) 또는최대수축기용적 (peak systolic volume) 등을이용하여진단할수있다 (5-9). 자가혈관을이용한동정맥루를형성할때문합부위의각도또한혈류의흐름에영향을미치며, 이로인해동정맥루폐색에도영향을줄수있을것이라생각이되지만아직이에대해보고된연구는없다. 이에본연구자들은액와정맥과위팔동맥사이에인조혈관동정맥루를시행한후폐색이있었던환자들에서문합부의각도를후향적으로분석하여문합부위의각도가동정맥루폐색에영향을주는지알아보고자하였다. 대상과방법 대상환자본연구는 Institutional review board 의승인을통과하였으며모든자료는이미종료된진료과정에서획득된영상자료의후향적인검토를통하여이루어진것으로대상환자의서면동의를얻는절차는생략하였다 년 3월부터 2011 년 12월까지혈액투석용동정맥루기능부전으로내원하여경피경관혈관성형술 (percutaneous transluminal angioplasty) 을시행한 272 예중인조혈관이혈전으로막혀혈전흡입술을시행한환자는 138 명이었다. 이환자중상완의위팔동맥과액와정맥사이에인조동정맥루를삽입한경우는 45명이었고, 본원에서추적관찰이가능했던 33명을대상으로하였다. 남녀비는 20 : 13, 나이는 37~83 세 ( 평균 67.5세 ) 였다. 수술로부터첫폐색까지의기간은 2~43 개월 ( 평균 17.0 ± 13.4 개월 ) 이었으며, 모든환자는폐색후 1주이내에동정맥루개통술이이루어졌다. 혈전제거방법인조혈관동정맥루의동맥문합부와정맥문합부에서각각국소마취 (2% lidocaine HCl, 명문제약, 화성, 한국 ) 후피부절개를하고초음파유도하에천자하였다. 천자한인조혈관내에각각유도철사를삽입한후 7.0 Fr 유도초 (Introducer sheath; Arrow International INC, Reading, PA, USA) 를삽입하였다. 이후유도초내의확장기를제거하고데이비드카테터 (David catheter; Cook medical, Bloomington, IN, USA) 를삽입한후혈관조영술을시행하여협착및혈전생성여부를확인하였다. 이때정맥문합부위를통과한카테터로조영제를주입하여중심정맥까지의개통성을확인한후혈관조영술이후협착이있는경우에는협착부의풍선확장술을시행하였다. 사용하는기구는직경 6~8 mm, 길이 2~4 cm 일반풍선카테터 (Cordis balloon catheter; Johnson & Johnson Company, Roden, Netherlands) 와커팅풍선카테터 (Cutting balloon catheter; Boston Scientific Corp., Galway, Ireland) 이며협착이있는부위를 10기압으로 1~2분간확장시켰다. 혈전이생성되어있는경우에는 7.0 Fr 유도카테터 (guiding catheter; Boston Scientific Corp., Plymouth, MN, USA) 를 10 cc 주사기에연결하여음압을유발시키면서전진과후진을 3~4차례반복하여혈전흡입술을시행하였다. 모든환자에서협착부위에풍선확장술을시행하였고 31명 (68.9%) 의환자에서혈전흡입술을시행하였다. 애로우-트레로톨라기구 (Arrow-Trerotola device; Arrow International INC, Reading, PA, USA) 는기계적혈전제거장비로서빠르게회전하는바스켓으로혈전을 1 mm 이하로잘게부수어흡입할수있는기구이다. 혈전증이심한경우이장치를이용하여기계적혈전제거술을시행하였다. 그리고시술종료전에정맥조영술을실시하여혈전유무및개통에대하여평가하였다. 시술의성공은잔존협착이 30% 이하이며정맥조영술상잔존혈전이없고시술이후동정맥루에서이학적검사상떨림을촉지할수있는경우로정의하였다. 환자는시술후본원외래또는응급실내원을통해동정맥루기능의이상유무를파악하였다. 동정맥루의기능부전으로혈액투석용중심정맥카테터를설치하거나혈관조영술을시행한경우는추적을종료하였다. 그리고첫시술이후에추적을종료한시점까지의개통일수를알아보았다. 또한, 동정맥루개통에영향을미치는인자로써정맥문합부와동맥문합부의각도를측정하였다. 정맥문합부각도는인조동정맥루와액와정맥이이루는각도를측정하였으며, 동맥문합부의각도는인조동정맥루와상완동맥이이루는각도를측정하였다. 각도의측정은일반적으로시술을하는자세 [ 팔을 90도외전한상태에서손바닥이위로향하게하고 c-형투시장치 (C-arm) 의각도는 0도로함 ] 에서촬영한투시영상을분석하였다. 환자의팔에변형이있어각도를측정할수없었던경우는없었다. 이외에환자의나이, 성별, 기저질환으로서고혈압과당뇨, 고지혈증, 심장질환, 뇌혈관질환여부를의무기록검토를통해후향적으로조사하였다. 통계첫시술후폐색까지의개통일수를 Kaplan-Meier method 를이용하여분석하였다. 정맥문합부와동맥문합부의각도와개통일수와의관계를상관분석을통해통계적으로유의한지알아보았다. 또한, receiver operating characteristics (ROC) 곡선을이용하여기준값 (cut off value) 이되는각도를구하였고그 206 대한영상의학회지 2013;68(3): submit.radiology.or.kr

3 김건영외 이상인군과미만인군으로나누어로그순위검정 (log rank test) 으로개통률을분석하였다. 그리고각군에서수술이후첫폐색까지의경과기간을독립표본 t-검정 (independent t-test) 으로비교하였다. 환자의나이 (70 세이상과미만인군 ), 성별, 기저질환 ( 고혈압, 당뇨, 고지혈증, 심장질환, 뇌혈관질환 ) 이개통일수에미치는영향에대해서도 log rank test 를이용하여분석하였다. 모든분석은 SPSS 20.0 for Windows (SPSS Inc., Chicago, IL, USA) 를이용하였다. 결과 모든환자에서정맥문합부의폐색이있었으며동맥문합부에만폐색이있었던경우는없었다 (Table 1). 문합부혈관의협착이모든환자에서있었으며혈전이동반되어혈전흡입술을시행한경우가 27명 (81.8%) 이었다 (Fig. 1). 22명 (66.7%) 에서는혈전흡입술과더불어 Arrow-Trerotola device 로기계적인혈전 제거술을사용하였다. 모든예에서성공적인혈전제거및풍선 확장술을하였으며추가적으로유로키나제 (urokinase) 를사용 했던경우는없었다 (Fig. 2). 1, 6, 12개월추적검사상동정맥 루의개통유지율은각각 75.8%, 39.4%, 9.1% 였다. 정맥문합부의각도와개통일수간에는상관성이있는것으 로나타났다. 정맥문합부의각도가 90도에가까운둔각일수록 개통이오래유지되었다 (r = 0.372, p = 0.033). 그러나동맥 Table 1. Occlusion Site in Arteriovenous Fistula Graft Cause Location Number Vascular stenosis Juxta-venous side only 11/33 (33.3) Juxta-arterial side only 0/33 (0) Both sides 22/33 (66.7) Thrombus formation Juxta-venous side only 3/33 (9.1) Juxta-arterial side only 0 (0) Both sides 24/33 (72.7) Parenthesis means percentage. A B C D Fig. 1. Images from a 76-year-old male patient who had occlusive symptoms. It was first occlusion after arteriovenous fistula formation. He was treated for brachiaxillary type AVF graft occlusion. A. There is stenosis and thrombosis in venous anastomosis site on angiogram. The anastomotic angle is 21. B. By using 6 mm-4 cm balloon catheter, balloon dilatation was performed to stenotic lesion. C. Thrombus within the graft was completely macerated and aspirated by using Arrow-Trerotola device. D. There is no stenosis and thrombosis in final angiogram. This patient s AVF primary patency was 19 days. Note.-AVF = arteriovenous fistula submit.radiology.or.kr 대한영상의학회지 2013;68(3):

4 위팔동맥 - 겨드랑정맥인조혈관동정맥루의폐색시경피적혈전흡입술후문합각이재협착에미치는영향 A B C Fig. 2. Images from a 41-year-old female patient. She was treated for brachiaxillary type arteriovenous fistula graft occlusion. A. Venous anastomotic site stenosis is shown on angiogram. The anastomotic angle is 60. B. Balloon dilatation was performed. C. There is no stenosis in final venogram. Her primary patency was 650 days. Patency (%) 문합부의각도와개통일수와의상관성은없었다 (r = 0.093, p = 0.643). 정맥문합부의각도에대하여 ROC 분석을실시하였 고상대적으로예각인군과둔각인군으로구분할수있는 cut-off value 는 34.5 도였다 도미만인군과 34.5 도이상 인군을비교했을때정맥문합부의각도가 34.5 도이상인군에 서오랫동안동정맥루의기능이유지되었다 (p = 0.03)(Fig. 3). 정맥문합부의각도가 34.5 도미만인군에서는 1, 6, 12 개 월추적검사상동정맥루의개통유지율이각각 69.2%, 33.3%, 0% 였고, 34.5 도이상인군에서는각각 80%, 62.5%, 30% 로나타났다. 또한두군에서수술후처음협착이발생했 을때까지의경과기간은 34.5 도미만인군에서 12.8 개월이었 고, 34.5 도이상인군에서 15.4 개월이었으며통계적으로유의 한차이를보이지는않았다 (p = 0.602). Under 34.5 Above 34.5 Total Days Fig. 3. Kaplan-Meier estimation of graft patency rates. The log rank test revealed a significantly longer graft patency for patients in whom venous side anastomotic angle is above 환자의나이, 성별, 기저질환과개통일수간의관계를평가 하기위하여실시한 log rank test 에서는나이가 70 세미만인경 Table 2. Kaplan-Meier Estimation of the Graft Patency Rates According to Various Parameters Parameters 우 (p = 0.069) 와뇌혈관질환이없는경우 (p = 0.051) 에개통 이오래유지되었지만통계적으로유의하지않았다 (Table 2). 고찰 No. of Patients Mean Patency Time* p-value Age < (48.5) 238 ± (51.5) 113 ± 24 Sex Male 20 (60.6) 165 ± 47 Female 13 (39.4) 187 ± 50 Hypertension 0.1 No 3 (9.1) 401 ± 248 Yes 30 (90.9) 151 ± 28 Diabetes No 6 (18.2) 257 ± 130 Yes 27 (81.8) 155 ± 31 Hyperlipidemia No 26 (78.8) 185 ± 42 Yes 7 (21.2) 131 ± 45 Heart disease No 27 (81.8) 172 ± 40 Yes 6 (18.2) 181 ± 56 Cerebrovascular disease No 27 (81.8) 196 ± 40 Yes 6 (18.2) 72 ± 44 Parenthesis means percentage. Note.-*Mean and standard deviation of patency time (day) of graft 본연구에서인조동정맥루의정맥문합부각도가 90 도에가 까운둔각일수록개통이오래유지되는결과를보였다. 그러나 208 대한영상의학회지 2013;68(3): submit.radiology.or.kr

5 김건영외 동맥문합부의각도는인조동정맥루의폐색에영향을주지않았다. Konner (10) 는가능한한정맥문합각도를평행하게하여예각을만들어야와류나혈관내벽의비후를피하고혈류의흐름에장해가없을것이라고주장하였다. 그이유로는동정맥루의빠른유속을가진혈류가반대편의벽에부딪혀혈관내막의비후를유발할수있기때문이라하였고, 특히각도가거의평행에가까울수록혈류가와류를만들지않을수있어오랜개통유지에도움을줄수있을것이라고하였다. 그러나이러한주장에대하여임상적인증거를제시하지는않았다. 하지만본연구에서는인공동정맥루에서정맥과인조혈관과의문합각도가예각보다는둔각일때폐색이더적었다. 아마도그이유로는혈류역학적인면과함께수술자체가문합부의혈관상태에영향을미칠수있기때문으로보인다. 문합부에서혈관절개의범위는혈관의직경과혈관문합각도에의해서결정된다 (10). 이식하는혈관의직경이같다고가정하면문합하는각도가 90도에가까울수록혈관측부의절개범위를작게만들수있다. 예를들어문합부의각도가 90도라면절개범위는측부로문합할혈관의직경과동일하게되지만각도가 30도라면절개범위는혈관직경의두배가된다. 혈관봉합과같은미세수술에있어서수술적외상의범위가늘어나는것은장기적으로혈관문합부에흉터가발생할가능성을증가시키며이로인한꼬임의가능성을증가시킬수가있다 (10). 따라서정맥문합부의각도를적절하게형성하는것이협착을예방하는데있어서중요한요소라고생각한다. 이외에도동정맥루폐색에영향을미칠수있는혈역학적인자들에대해서몇몇연구가이루어졌다. 동맥의직경이나정맥의직경이작을수록개통이유지되는기간은짧았다 (11). 도플러검사에서주먹을쥐어위팔의반응성충혈을일으킨상태에서주먹을풀면최대수축용적이증가하면서혈류흐름패턴이삼상 (triphasic) 에서단상 (monophasic) 으로바뀌게된다. 이러한흐름의변화를저항지수를이용하여정량화할수있고, 이는동정맥루폐색의예측인자가된다 (9). 또한, 혈류의양도영향을미칠수있는데, 정상적인동정맥루에서분당혈류량은 1000 ml 를초과할수있다. 이는일반적인말초동맥의혈류량인분당 20~30 ml 보다많으며수술직후에는적어도 200~300 ml 가유지되어야한다고알려져있다 (4). 수술중혈류의흐름을측정하였을때분당혈류량이 120 ml 미만인경우에조기폐색의원인이될수있으며 (12), 분당 200 ml 미만의혈류량일경우에는일차개통률과이차개통률이모두감소될수있다고하였다 (13). 이러한결과들을종합해볼때, 동정맥루형성시문합부의각도에대한고려와함께혈류의흐름에대한정량적인분석이동정맥루의오랜개존에도움이되리라생각된다. 본연구에서인조혈관동정맥루의개통률은환자의나이, 성별에의해영향을받지않았다. 그리고, 기저질환인고혈압, 당뇨, 고지혈증, 심장질환, 뇌혈관질환여부도동정맥루의폐색에영향을주지않았다. 기존메타연구에따르면나이가많은환자들에서개통률이감소하는것으로알려져있다 (14). 다만이러한연구는자가혈관을대상으로한것이며, 기준이되는나이를정의하는데있어서범위가 50~70 세로통일되지못하였다. 그러나성별에따라서는개통률에큰차이가없다고하였다 (15). 기저질환에따른개통률에대해서이전에당뇨와저혈압, 동맥경화증과의연관관계에대해연구가수행되었다 (16, 17). 현재당뇨가있는환자들에대해서인조혈관을이용하는경우가늘어나는추세이다. Sedlacek 등 (18) 은동맥경화도의증가에도불구하고혈관구경이나동맥의최대수축용적이당뇨와비당뇨환자군에서크게다르지않다고보고하였다. 이러한환자들에대해동정맥루를조성하였을때효과적인결과를나타냈으며당뇨유무에관계없이비슷하였다. Konner 등 (19) 은당뇨환자에서근위부동정맥루사용시일차개통률은비당뇨환자군과큰차이가없었으며 24개월후의이차개통률에있어서감소했음을보고하였다. 본연구의결과에서도당뇨유무에따라서개통률에는큰차이가없는것으로나타났다. 본연구에는몇가지한계가있다. 첫째로문합부의각도를측정하는데있어서이차원적인투시영상을이용하였기때문에삼차원적인구조를정확하게분석하는데있어서오류가있을수있다. 두번째로는위팔동맥과액와정맥을연결한인조혈관을이식한환자들만을대상으로하였기때문에다른부위에인조동정맥루를형성한환자들에대해서일반화하기가어려울것이라생각된다. 결론적으로인조혈관을이용한위팔동맥-액와정맥의동정맥루조성환자에서정맥문합부의각도는동정맥루개통유지기간과연관이있으며, 각도가둔각일수록개통이오래유지될수있다. 또한나이, 성별과기저질환인고혈압, 당뇨, 고지혈증, 심장질환, 뇌혈관질환은개통유지와연관이없었다. 참고문헌 1. Bell DD, Rosental JJ. Arteriovenous graft life in chronic hemodialysis. A need for prolongation. Arch Surg 1988; 123: Turmel-Rodrigues L, Pengloan J, Baudin S, Testou D, Abaza M, Dahdah G, et al. Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts by interventional radiology. Nephrol Dial Transplant 2000;15: submit.radiology.or.kr 대한영상의학회지 2013;68(3):

6 위팔동맥 - 겨드랑정맥인조혈관동정맥루의폐색시경피적혈전흡입술후문합각이재협착에미치는영향 3. Butterworth PC, Doughman TM, Wheatley TJ, Nicholson ML. Arteriovenous fistula using transposed basilic vein. Br J Surg 1998;85: Wedgwood KR, Wiggins PA, Guillou PJ. A prospective study of end-to-side vs. side-to-side arteriovenous fistulas for haemodialysis. Br J Surg 1984;71: Kim YO, Choi YJ, Kim JI, Kim YS, Kim BS, Park CW, et al. The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. J Korean Med Sci 2006;21: Malovrh M. Non-invasive evaluation of vessels by duplex sonography prior to construction of arteriovenous fistulas for haemodialysis. Nephrol Dial Transplant 1998;13: Kim YO, Song HC, Yoon SA, Yang CW, Kim NI, Choi YJ, et al. Preexisting intimal hyperplasia of radial artery is associated with early failure of radiocephalic arteriovenous fistula in hemodialysis patients. Am J Kidney Dis 2003; 41: Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 1996;12: Malovrh M. Native arteriovenous fistula: preoperative evaluation. Am J Kidney Dis 2002;39: Konner K. The anastomosis of the arteriovenous fistula-- common errors and their avoidance. Nephrol Dial Transplant 2002;17: Glass C, Johansson M, DiGragio W, Illig KA. A meta-analysis of preoperative duplex ultrasound vessel diameters for successful radiocephalic fistula placement. J Vasc Ultra- sound 2009;33: Saucy F, Haesler E, Haller C, Déglise S, Teta D, Corpataux JM. Is intra-operative blood flow predictive for early failure of radiocephalic arteriovenous fistula? Nephrol Dial Transplant 2010;25: Lin CH, Chua CH, Chiang SS, Liou JY, Hung HF, Chang CH. Correlation of intraoperative blood flow measurement with autogenous arteriovenous fistula outcome. J Vasc Surg 2008;48: Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007;45: Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 2004;28: Culp K, Flanigan M, Taylor L, Rothstein M. Vascular access thrombosis in new hemodialysis patients. Am J Kidney Dis 1995;26: Ku YM, Kim YO, Kim JI, Choi YJ, Yoon SA, Kim YS, et al. Ultrasonographic measurement of intima-media thickness of radial artery in pre-dialysis uraemic patients: comparison with histological examination. Nephrol Dial Transplant 2006;21: Sedlacek M, Teodorescu V, Falk A, Vassalotti JA, Uribarri J. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis 2001;38: Konner K, Hulbert-Shearon TE, Roys EC, Port FK. Tailoring the initial vascular access for dialysis patients. Kidney Int 2002;62: 대한영상의학회지 2013;68(3): submit.radiology.or.kr

7 김건영외 위팔동맥 - 겨드랑정맥인조혈관동정맥루의폐색시경피적혈전흡입술후문합각이재협착에미치는영향 1 김건영 1 진공용 1,2 황승배 1,2 최은정 1 송지수 1 한영민 1,2,3 권근상 4 목적 : 위팔동맥-액와정맥사이인조동정맥루수술환자에서개통률에영향을미치는인자를알아보고자하였다. 대상과방법 : 위팔동맥-액와정맥사이인조동정맥루수술후처음으로협착이발생하여경피경관혈관성형술을시행한 33명 ( 남자 20명, 여자 13명 ; 평균나이, 67.5 세 ; 수술후첫번째폐색까지의평균기간, 17 개월 ) 의환자들에대하여후향적으로연구하였다. 나이, 성별, 기저질환 ( 고혈압, 당뇨, 고지혈증, 심혈관질환, 뇌혈관질환 ), 정맥문합부의각도및동맥문합부의각도가첫협착후개통기간에미치는영향을분석하였다. 통계적분석에는 Kaplan-Meier method 및 log rank test 와 receiver operating characteristics curve analysis 를이용하였다. 결과 : 시술 1개월, 6개월, 12개월후의위팔동맥-액와정맥사이인조동정맥루의개통유지율은각각 75.8%, 39.4%, 9.1% 였다. 정맥문합부의각도와개통기간사이에상관관계가있었으며 (r = 0.372, p = 0.033), 정맥문합부의각도가클수록 (34.5 도이상 ) 오랫동안동정맥루기능이유지되었다. 그러나동맥문합부의각도와개통일수와의상관성이없었다 (r = 0.093, p = 0.643). 결론 : 위팔동맥-액와정맥사이인조동정맥루를가진환자에서정맥문합부의각도가둔각일수록개통이오래유지될수있다. 전북대학교의학전문대학원전북대학교병원 1 영상의학과, 2 의과학연구소, 3 심혈관연구소, 4 예방의학교실 submit.radiology.or.kr 대한영상의학회지 2013;68(3):

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