CT血管成像在血液透析患者血管通路维护中的应用

目的应用CT血管成像（computed tomographic angiography,CTA）技术辅助维持性血液透析（maintenance hemodialysis,MHD）患者动静脉内瘘（arteriovenous fistula,AVF）的维护。方法对45例进行CTA检测的MHD患者AVF的维护进行观察,应用64排螺旋CT血管成像技术分析AVF功能不良、AVF原发失败、AVF静脉高压症的原因,指导临床干预措施,观察干预效果。结果45例患者成功进行CTA检测47次,明确血管病变100%,在CTA结果指导下完成AVF修复或重建38例次,建立带涤纶套深静脉留置导管3例次,未予手术干预但指导AVF穿刺6例次,干预后血管通路短期（1个月）通畅率100%。结论对于血液透析AVF及其相关并发症,64排螺旋CTA可基本无创地显示瘘血管的全貌,有效地辅助维护AVF。

Application of computed tomographic angiography on maintenance hemodialysis patients

Objective To summarize the application of computed tomographic angiography（CTA） on handling of arteriovenous fistulas（AVF） in maintenance hemodialysis patients（MHD） in one dialysis union.Methods Forty-five MHD patients with internal fistula were detected by 64 row spiral CTA.The location,degree of vessel stenosis,and collateral circulation were evaluated with 3D reconstructional imaging,including maximum intensity projection（MIP） and volume rendering（VR）.The reasons of AVF dysfunction,original failure,and venous hypertension were analyzed according to the results of CTA.The results of interventions on AVF were observed.Results All vasculopathy of AVF in 45 MHD patients was identified by 47 times of CTA test.There were 38 AVF recovery or re-established operations and 3 indwelling catheters with cuff.Six AVF were not treated by operation.The patency rate of new blood vessel accesses was 100% in one month.Conclusion CTA is helpful to the therapy of AVF in MHD patients.