ランチョンセミナー - 池田バスキュラーアクセス・透析・内科クリニック

第18回日本アクセス研究会
ランチョンセミナー（メディコン)
2014年11月30日（日） 12：15～13：15
あわぎんホール第1会場
AVF狭窄に対するPTAへの科学的アプローチ
～Low Pressure Techniqueの
可能性を検証する～
池田バスキュラーアクセス・透析・内科クリニック
池田潔
図3A
動脈圧と血管径の同時記録例
佐藤隆幸著「血管の粘弾性」
図3B 動脈圧－血管径関係を示すリサージュプロット
佐藤隆幸著「血管の粘弾性」
6atm.
4 atm.
Mean =3.67mm
Mean =4.23mm
Ｓalt Lake City Utah
23-24 2014
CIDA
Multiple Repeated
Low Pressure Technique
IKEDA Vascular access dialysis
Internal Medicine clinic
Tohru Yasuda , Kiyoshi Ikeda
AVF Patency rate
2003 ～2010
(%)
100
90
80
Incomplete ballooning 412 cases
70
60
50
40
30
20
10
0
0
50
100
150
きかん
200
250
300
(days)
AVF Patency rate
2003 ～2010
(%)
100
90
80
Incomplete ballooning 412 cases
70
60
50
NS
40
Complete ballooning 567 cases
30
20
10
0
0
50
100
150
200
250
300
(days)
AVF Patency rate
(%)
3M
2003 ～2010
6M
100
Incomplete 80% 27%
90
Complete 62% 25%
Dr.Sato et al
80
Incomplete ballooning 412 cases
70
60
50
Complete balloning 567 cases
NS
40
0
50
100
150
きかん
200
250
300
(days)
New Low Pressure Technique (LPT)
Pre PTA
6atm x 30sec
2atm x 30sec
7atm x 30sec
3atm x 30sec
8atm x 30sec
4atm x 30sec
Post PTA
①New Low Pressure Technique (LPT) is an attempt to maximize
blood flow rate when using maximum pressure is not an option.
②In this example of LPT we take a balloon rated to 15atm
but only using it up to its nominal pressure of 6atm.
Beginning at 1atm and expanding and contracting the balloon
20 to 25 times a minute while increasing the pressure
by 1 atm every minute up to the nominal pressure of 6atm.
Total time is 6 minutes and in some cases slight more time.
③Balloon expansion is gradually increased during the first
5 minutes to full vein size in the final minute.
④This method applies to all balloon pressures and is used
accordingly based on the balloon's rated pressure and
nominal pressure.
One of the goals of this technique is to achieve full expansion at
low pressure.
※Super-non-compliant balloon (CONQUEST®, Yoroi®)
Super-non-compliant balloon vs Others
Dog-bone phenomenon
As shown in the figure, group B, when
using a semi-compliant balloon that
looks like it is being bitten by a dog,
causes intimal injury and the main
objective is not achieved due to the fact
that the balloon expands beyond the
optimal size.
6atm
Super-non-compliant Balloon
As shown in the figure, group A, using a
super non-compliant balloon eliminates
the occurrence of dog bone
phenomenon.
Vein damage is also avoided because the
balloon is limited in its expansion.
7atm
第2回
九州バスキュラーアクセスライブフォーラム201
熊本・福岡メイン会場にて
サテライト会場を
九州５か所に設置し開催
頻回低圧拡張法実演
第2回九州バスキュラーアクセスライブフォーラムにて（2014.11.9）
Compliant balloon
at 14atm
Lt. AVF
Conquest
at 10atm
Japanese medical treatment
covered by health insurance
・Only 1 PTA / 3 months
・Only 1 balloon
・Stent usage not permitted
in Fukuoka area
・stretching gradually
・repeated 10 times /30sec
Flow volume＜400ml/min
Pulsasion Index ＞1.2
Stenosis diameter＜1.0mm
Case 1
Lt. AVF
stenosis
・Flow volume
300ml/min
・Pulsasion index
2.0
・Stenosis diameter
0.8mm
Conquest at 2atm / 30sec
Conquest at 4atm / 30sec
Conquest at 6atm / 30sec
Conquest at 6atm / 90sec
After PTA
・Flow volume
300→500ml/min
・Pulsasion index
2.0→1.0
・Stenosis diameter
0.8→2.9mm
before
Case 2
・Flow volume
360ml/min
・Pulsasion index
1.6
・Stenosis diameter
1.6mm
Lt. AVF
Conquest at 10atm / 120sec
After PTA
・Flow volume
360→500ml/min
・Pulsasion index
1.6→1.2
・Stenosis diameter
1.6→3.2mm
before
AVF Patency rate
- using Conquest (%)
100
80
60
70%
3M
40
30%
6M
20
0
0
50
100
150
200
41 cases
250
Average pressure 8.8atm
Average balloon size 5.1mm
300
(days)
Conclusion
Repeated low pressure technique is effective
method for expanding without rupture.
Dog-bone phenomenon can be avoided
by using super-non-compliant balloon.

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