THE TREATMENT OF CHRONIC-HEMODIALYSIS VASCULAR ACCESS BY DIRECTIONAL ATHERECTOMY

Directional atherectomy (DA) was developed as a new therapeutic modali ty for coronary artery disease. For the past 3 years, we have applied DA intervention to vascular access failure with poor blood flow rate o r high venous pressure. DA intervention was performed on 27 stenosis t o less than 20% of that before treatment was judged a technical succes s, and the rate of technical success was 84%. All patients showed adeq uate blood flow rates after DA intervention, indicating initial succes s. Although restenotic events occurred frequently, repeated DA interve ntions could be performed successfully. The patency rate at 1 month af ter DA intervention was 100%, at 3 months 93%, at 6 months 92% and at 12 months 75%. The short-term patency rate of DA was more satisfactory than the results of percutaneous transluminal angioplasty as reported by several investigators. Regarding the site of stenosis, restenotic events were relatively fewer in the lesions occurring at the native ve in compared to those at graft-venous anastomotic sites. Eccentric-type stenosis was also associated with fewer restenotic events than circum ferential-type stenosis. These results suggest that eccentric-type ste nosis at the native vein is the most suitable lesion for the applicati on of DA intervention in terms of long-term patency. As no severe comp lications occurred after DA intervention, this would appear to be a us eful therapeutic modality for the correction of vascular access failur e.