Kidney Research and Clinical Practice

Korean Society of Nephrology (대한신장학회)
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Early Detection of Hemodialysis Arteriovenous Fistula Dysfunction with Intra-access Static and Total Pressure Measurement

혈액투석을 위한 동정맥루 내 정압 및 전압 측정을 통한 기능 부전의 조기 진단

Lee, Jong-Hoon;Park, Sung-Il;Yoon, Soo-Young;Lee, Sang-Choel;Yang, Sung-Ja;Ahn, Hyung-Joon;Park, Ki-Il;Kim, Yu-Seun
이종훈;박성일;윤수영;이상철;양성자;안형준;박기일;김유선

  • Published : 20070100
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Abstract

Purpose: To detect the dysfunction of arteriovenous fistula (AVF) early, we have developed a new method to calculate the intra-vascular conduit flow rate based on the Bernoulli`s theory. However, this method has limitation on detection of inflow stenosis. For detection of both in- and out-flow stenosis, we tried to measure intra-access static (pS) and total pressure (pT), and compared with angiographic findings. Methods: From a total of 46 cases of native AVFs, of at least 3 months of construction, intra-access pS and pT were measured, before starting hemodialysis. Δp (pT-pS) and pT/mean arterial pressure (MAP) ratio were calculated, and compared with angiographic findings. Results: Among 37 patients without outflow stenosis (Vs) in fistulogram, 10 patients with inflow stenosis (As) had significantly lower pT/MAP ratio and Δp than those without As patients (p<0.005). Among 34 patients without As, Δp was significantly lower in 7 patients with Vs than those 27 patients without Vs (p=0.001). Conclusion: pT/MAP ratio was correlated with As, and Δp reflects Vs in angiography. The measurement of pS and pT might be useful to predict inflow and outflow stenosis of AVFs.

목 적: 동정맥루의 혈류감시를 위해 동정맥루 내 정압과 전압을 측정하고, 평균 동맥압을 이용하여 표준화 하였고, 이 결과를 혈관조영술에 의한 혈관의 협착 유무와 비교하였다. 본 연구의 목적은 동정맥루 내의 압력과 혈관조영술에 의한 혈관의 협착 유무를 비교하여, 본 연구 방법의 임상적 의의를 확인하고자 함이다. 방 법: 자가 혈관으로 조성된 동정맥루로 혈액투석을 하고 있는 환자 46명을 대상으로, 혈액투석 시작 전 혈액 투석용 바늘로 동맥 측 천자를 한 후, 그 말단에서 전압 (PT)과 정압 (Ps)을 측정하였다. PT와 Ps 차이 (ΔP)와 PT와 평균 동맥압의 비 (PT/MAP ratio)를 각각 계산 하였다. 동시에 혈관조영술을 시행하여 동정맥루의 동맥 측 천자 부위 이전 (As)과 이후 부위 (Vs)의 협착 정도를 pixel로 측정하여 50 % 이상일 경우 임상적 의미가 있다고 판정하였고, 의미 있는 협착이 있는 군과 없는 군 사이의 PT/MAP ratio와 ΔP를 비교하였다. 결 과: Vs가 없었던 37명의 환자에서 As가 50% 이상인 환자 (10명)의 PT/MAP ratio는 평균 0.65±0.21로 As가 50% 이하이거나 관찰되지 않은 환자 (27명)의 0.97±0.15에 비해 유의하게 낮았다 (p=0.001). ΔP도 각각 평균 52.3±30.4 mmHg와 73.4±30.4 mmHg로 유의한 통계적 차이를 보였다 (p=0.014). As가 없는 34명의 환자 중 Vs가 50% 이상인 환자 (7명)에서 ΔP는 평균 27.3±16.8 mmHg로 Vs가 50% 이하이거나 관찰되지 않은 환자 (27명)의 73.3±18.1 mmHg에 비해 유의한 통계적 차이가 있었다 (p= 0.001). 결 론: 동정맥루 내에서 측정된 PT/MAP ratio는 유입 혈관 (동맥, 문합부 혹은 주위 정맥)의 협착 소견을, ΔP (PT-Ps)는 유출 정맥의 협착 소견을 각각 반영하며, 감소된 PT/MAP ratio로 유입 혈관의 협착을, 감소된 ΔP로는 유출 정맥의 협착을 진단할 수 있다.

Keywords

References

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