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논문분류	춘계학술대회 초록집
제목	Stenting at migrated stent
저자	Jin ho LEE, Hee yeoun KIM, Dongyeol LEE, Joon seok OH, Seong min KIM, Yong ki PARK, Yong hun SIN, *Joong kyung KIM
출판정보	2017; 2017(1):
키워드	Central vein stenosis, Stent placement, overlapping stent
초록	Case Study : Central vein stenosis(CVS) is commonly associated with arteriovenous fistula for hemodialysis. CVS associated with increased morbidity, hospitalization and morbidity. Endovascular intervention should be considered to management of CVS, such as balloon angioplasty, stent deployment. Especially, stenting at refractory CVS was choice of treatment. We announced a case that overlapping another stent between previous migrated stent and refractory CVS compressed by thyroid mass. 75-year-old woman with advanced DM nephropathy on hemodialysis. Rt. Brachiocephalic AVF op was done at Jan, 2016. Rt. arm swelling and delayed hemostasis was occurred at POD 60days. We decided percutaneous transluminal angioplasty(PTA). Significant Rt. brachiocephalic vein(>80% stenosis) and collateral veins was presented. Despite of 12mm balloon angioplasty(MUSTANGTM), stenosis(70~80%) was remained(Fig.1, Fig.2, Fig.3). To find reason of elastic recoil, enhanced chest CT was performed. CT shows Rt. brachiocephalic vein was compressed by thyroid mass(3.4 X 2.7mm), Rt. brachiocephalic artery and 1st rib(Fig.4). Then, stent(WALLSTENTTM, 14mm X 4cm) was placed at stenotic lesion because of high radial resistive strength(Fig.5). Immediate technical success was achieved. But, ipsilateral arm edema was recurred 3days after intervention. In central venography, stent was migrated into SVC and Rt. brachiocephalic vein stenosis was remained(Fig.6). Stent(EPIC TM, 14mm X 4cm) was overlapped between CVS and migrated stent(Fig.7). Arm swelling was disappeared. Stent deployment was one of treatment choice of CVS. But, stent migration often occurred and could be a risk to patient. Our patient was treated by overlapping 2nd stent placement between primary CVS and migrated 1st stent tip.
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