多普勒超声对老年人下肢自发性动静脉瘘的诊断价值

目的探讨老年人下肢自发性动静脉瘘的多普勒超声特点及其诊断价值。方法回顾性分析经数字减影血管造影技术诊断为自发性动静脉瘘的15例下肢动脉粥样硬化老年患者,通过彩色多普勒超声观察伴行动静脉之间有无瘘口和分流血流,并对血流频谱进行分析。结果 15例自发性动静脉瘘患者最后经手术证实均患有下肢动脉粥样硬化13例,其中(1)二维超声显示10例相邻动静脉之间存在瘘口,与13例术后结果比较,诊断符合率76.9%。(2)彩色多普勒(CDFI)显示12例相邻动静脉(或瘘口)局部出现"五彩镶嵌"血流,脉冲多普勒(PW)于瘘口处探及高速低阻动脉血流,与术后结果比较诊断符合率92.3%(12/13)。结论彩色多普勒超声方便、快捷、无创,可作为老年人下肢自发性动静脉瘘首选检查方法。     

彩色多普勒超声在Klippel-Trenaunay综合征和Parkes-Weber综合征诊断中的临床应用

目的:探讨彩色多普勒超声在Klippel-Trenaunay综合征(KTS)和Parkes-Weber综合征(PWS)患者的诊断和鉴别价值。方法:回顾性分析我院经临床和影像学检查确诊的65例KTS和PWS患者彩色多普勒超声检查资料,对其动静脉病变进行比较。结果:超声检查发现KTS和PWS皮肤的葡萄酒色血管痣或血管瘤62例(95.4%);患肢增粗、增长61例(93.8%),KTS表现为深静脉缺如或管径变细,内径明显小于同名动脉,流速较低;PWS以多发动静脉瘘为特征,深静脉可变细,近瘘口处血管相对较粗伴流速增高。KTS与PWS两组间股静脉流速差异有统计学意义(P<0.01),腘静脉流速差异有统计学意义(P<0.05),两组间大隐静脉流速及内径差异、股静脉和腘静脉内径差异均无统计学意义(P>0.05)。结论:彩色超声检测对KTS和PWS的诊断和鉴别有较好的临床应用价值。     

彩色多普勒超声诊断多发性大动脉炎的外周血管病变

目的 探讨彩色多普勒超声对多发性大动脉外周血管病变的诊断价值.方法 使用二维及彩色多普勒超声对22例多发性大动脉炎的外周血管进行检查,分析病变动脉的二维声像图及彩色多普勒超声特征.结果 22例多发性大动脉炎受累动脉分布情况:颈总动脉15例,锁骨下动脉13例,腹主动脉7例,肾动脉3例,股总动脉1例,肠系膜上动脉1例.受累动脉二维声像图表现多为动脉管壁弥漫性向心性增厚,管腔出现不同程度的狭窄、闭塞,彩色多普勒超声多表现为受累动脉内血流束变细、消失,部分出现盗血.结论 彩色多普勒超声可较准确、直观地反映多发性大动脉炎的受累范围及受累动脉病变情况,可作为多发性大动脉炎的常规检查.     

彩色多普勒超声在血液透析患者高位动静脉内瘘首次穿刺中的应用效果分析

目的探讨彩色多普勒超声在血液透析患者高位动静脉内瘘首次穿刺中的应用效果。方法选择2014-10~2016-10血液净化中心采用高位动静脉内瘘血管通路维持血液透析治疗68例患者,按随机数字表法分为观察组和对照组各34例。观察组应用彩色多普勒超声监测血管状态,定位动静脉端穿刺点穿刺内瘘血管。对照组由血透专业护理人员经验性判断内瘘血管走向、深浅度确定动静脉端穿刺点穿刺内瘘血管。结果观察组血透患者内瘘穿刺首次成功率高于对照组(P0.05);血管通路的并发症如皮下血肿、局部血管硬化和血栓形成发生率显著低于对照组(P0.05)。结论上臂高位动静脉內瘘首次穿刺前采取彩色多普勒超声评估血管定位穿刺点,可以指导首次穿刺顺利进行,明显提高内瘘穿刺成功率。     

E-Flow血流显像技术对胎儿冠状动脉瘘的诊断价值

目的探讨E-Flow血流显像技术对胎儿冠状动脉瘘的诊断价值。方法在胎儿超声心动图检查中除使用常规彩色多普勒外加用了E-Flow血流显像技术,产前诊断冠状动脉瘘5例。使用Alokaα10彩色超声诊断仪,探头频率为3.5～5.0 MHz。对二维超声(2D)发现胎儿一侧心房、心室异常增大或冠状动脉增粗的患者,进一步探查冠状动脉。先以彩色多普勒超声(CDFI)获取心腔内异常血流,再以连续多普勒(CW)获取舒张期为主的高速血流频谱,初步证实该异常血流来自于冠状动脉。此时启动E-Flow显像模式追溯该异常血流。结果 5例胎儿冠状动脉瘘均出生后经超声证实。其中2例为左冠状动脉右心室瘘、1例为左冠状动脉右心房瘘,1例为右冠状动脉右心房瘘,1例为右冠状动脉右心室瘘。E-Flow显像技术能够敏感地捕捉冠状动脉瘘血流,清晰显示冠状动脉瘘的起源、瘘管的走行以及瘘口的位置、大小,其血流显像优于传统的彩色多普勒。结论应用E-Flow显像技术可以在产前更加准确、快速地诊断胎儿冠状动脉瘘。推荐E-Flow血流显像技术成为胎儿冠状动脉瘘的诊断工具之一。     

彩色多普勒超声诊断急性上肢动脉栓塞的价值探讨

总结分析我院收治的8例急性上肢动脉栓塞的二维、彩色多普勒、频谱多普勒超声检查资料。结果栓塞部位二维超声主要表现为栓塞处管腔实质团块;彩色多普勒显示,完全性栓塞时阻塞段彩色血流信号中断或消失,不完全栓塞时可见沿血管内壁一侧走行、五彩镶嵌、不规则细条状彩色血流;脉冲多普勒显示,栓塞处动脉管腔内未探及血流频谱。认为彩色多普勒超声诊断急性上肢动脉栓塞方便、快捷、准确、敏感,可作为首选检查方法。     

彩色多普勒超声对心脏粘液瘤的诊断价值

目的　探讨彩色多普勒超声对心脏粘液瘤的诊断价值。方法　应用 H P 10 0 0型多普勒超声心动诊断仪 ,对 18例心脏粘液瘤患者进行检查 ,采用 M型、二维超声观察粘液瘤对心脏各腔、瓣口的影响 ,运用彩色多普勒血流显像、脉冲多普勒 ( PW )、连续多普勒 ( CW )观察瓣口的血流频谱。结果　心脏粘液瘤主要表现为其所对的瓣膜的损伤引起的反流和瓣口堵塞所造成的有效瓣口面积的减少。结论　彩色多普勒超声心动图是诊断心脏粘液瘤的最佳方法 ,具有无创、安全、可重复及诊断正确率高的优点     

下肢动脉血栓形成致血管狭窄的彩超诊断及定量分析

选择2013年1月-2015年12月间,我院收治的,获得明确诊断的下肢动脉血栓患者53例作为研究对象,对其展开彩色多普勒超声检查,并对检查结果进行统计分析。结果统计发现,在狭窄程度不足25%时,动脉远端脉冲多普勒频谱未发生显著改变,狭窄度在25%~50%之间时,动脉远端血流的速度会发生显著降低,脉冲多普勒频谱并未发生原则改变;狭窄程度超过50%时,动脉远端脉冲多普勒频谱表现出,收缩期峰值速度降低的单相波形;闭塞后,血流信号彻底消失。结论经彩色多普勒超声检查可对动脉血栓血管狭窄程度进行准确分析,可为临床诊断和治疗提供可靠的参考依据,临床价值显著,值得关注。     

彩色多普勒超声在股动脉穿刺术后血管并发症诊治中的价值

目的探究彩色多普勒超声在股动脉穿刺术后血管并发症诊治中的应用价值。方法选择我院心内科2012年5月—2017年4月收治的53例行股动脉穿刺术后发生血管并发症的住院病人作为研究对象,所有病人均行彩色多普勒超声检查,并根据超声检查结果进行针对性治疗,分析血管并发症病人的血流状态及肿块内部回声,根据治疗后的效果,评价彩色多普勒超声诊断的应用价值。结果 49例(92.5%)病人为单纯假性动脉瘤,2例(3.8%)病人为动静脉瘘,1例(1.9%)病人为假性动脉瘤合并股深、浅动脉瘘,1例(1.9%)病人为股静脉前壁窦道形成;经超声诊断和超声引导下针对性治疗,53例病人术后均恢复良好,未发生病情严重进展和其他扩展并发症。结论采用彩色多普勒超声对行股动脉穿刺术后发生血管并发症的住院病人进行诊治,不仅能有效确保诊断结果的准确率,同时还能有效提升治疗的有效率。     

彩色多普勒超声对主动脉瘤的诊断价值

目的 探讨彩色多普勒技术对主动脉瘤的诊断价值。方法 应用彩色多普勒技术分析临床证实为主动脉瘤的12例病人的超声图像,包括瘤体大小、形态、内部回声、血流方向、血流速度等。结果 彩色多普勒均能显示动脉瘤体大小、范围、动脉管壁情况及瘤腔内的血流信号,其中5例主动脉夹层可显示真、假腔及破口的血流频谱信号。有硬化斑及血栓者可见血流充盈缺损。结论 彩色多普勒超声对诊断主动脉瘤有较高的价值。     

Using two-holed needles for both arterial and venous accesses to the arteriovenous fistula to improve flow during hemodialysis

This prospective study compared methods using both arterial and venous needles with back eyes with those using only arterial needle with back eye for arteriovenous fistula cannulation. Sixty-one patients receiving hemodialysis (HD) via an arteriovenous fistula were evaluated. All patients underwent arteriovenous fistula puncture using only arterial needle with back eye in first 3 months and both arterial and venous needles with back eyes in following 3 months. Arterial and venous pressures, blood flow velocities, total blood volume cleared, and Kt/V values were compared. Mean blood flow velocity, arterial pressure, Kt/V, and cleared total blood volume values were higher and venous pressure was lower in patients who underwent cannulation using both needles with back eyes than in those with only the arterial needle with back eye. For arteriovenous fistula cannulation, using both arterial and venous needles with back eyes provides adequate HD more successfully.     

Congestive heart failure due to traumatic arteriovenous fistula--two case reports

Arteriovenous fistulas are abnormal connections between the high-pressure and high-resistance arterial system and the venous system with opposite features. Due to its lower resistance, the blood preferentially flows via the fistula rather than through the capillary bed. The amount of shunt flow depends on its size and proximity to the heart. Due to the increase in circulating volume, progressive dilation develops in the whole vascular system proximal to the shunt. Cardiomegaly and venous distention may return to normal after surgical repair of this vascular abnormality. Two cases are presented of heart failure due to traumatic arteriovenous fistula, one of which was between the right renal artery and inferior vena cava and the other between the left renal artery and renal vein.     

Noninvasive assessment of arteriovenous fistula.

Noninvasive diagnostic techniques permit objective assessment of the presence, location, and hemodynamic alterations associated with congenital or acquired arteriovenous fistulas. Doppler ultrasound may be used to assess abnormal velocity signals and directional blood flow in afferent and efferent limbs of the fistula, as well as abnormal pressure gradients in the involved extremity. Plethysmography permits graphic qualitative assessment of pulse wave form alterations before and after compression of the fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula. In addition, venous occlusion plethysmography permits quantitation of limb or digit blood flow before and after fistula compression. Illustrative cases of congenital and acquired arteriovenous fistulas demonstrate the utility of these noninvasive techniques in the objective assessment of patients.     

复合手术室内治疗伴静脉曲张的软脑膜动静脉瘘一例并文献复习

颅内软脑膜动静脉瘘为一种十分罕见的脑血管畸形,其由供血动脉、瘘口、引流静脉构成,且动静脉之间无畸形血管团。但由于引流静脉内的高流量特点,汇入引流静脉的正常静脉回流受阻,可导致静脉曲张现象,从而易误诊为颅内动静脉畸形。对软脑膜动静脉瘘保守治疗的病死率较高,建议行外科及血管内治疗,且仅需要消除瘘口,阻断动静脉间血流沟通即可。作者通过报道1例由大脑前动脉供血的软脑膜动静脉瘘的治疗体会,结合国外文献报道,探讨软脑膜动静脉瘘的定义、诊断及治疗。     

Impact of a large hemodialysis arteriovenous fistula: on myocardial protection during cardiopulmonary bypass

Arteriovenous fistulae have a substantial impact on systemic hemodynamics, but their effect on cardiopulmonary bypass is not well understood. The left-to-right shunting of blood through an arteriovenous fistula can create flow problems during cardiopulmonary bypass. We present the case of a 59-year-old man with end-stage renal disease who underwent coronary artery bypass grafting. During surgery, a large brachiocephalic arteriovenous fistula provided excessive venous return to the heart, compromising the myocardial protection offered by cardiopulmonary bypass. We modified the venous cannulation from a 2-stage single cannula to a bicaval cannula and were then able to achieve cardioplegic arrest and myocardial protection with no further problems.     

Contribution of ultrasonography in late maturation of native fistulae for chronic hemodialysis

Early failure of arteriovenous fistulae for chronic hemodialysis can be avoided with early preoperative physical examination and complementary explorations. Nevertheless, insufficient development of the arteriovenous fistula after 3 months remains a frequent problem which is sometimes difficult to manage clinically. Duplex-Doppler is the fundamental exploration allowing distinction between pseudo-retard in maturation and true retard with low flow rate. In the first case, blood flow and venous and arterial caliber are normal but unfavorable anatomic conditions may result in superficialization. In the second case, blood flow is too with a true insufficiency in the venous caliber. An exhaustive exploration of the venous and arterial vessels allows accurate diagnosis of arterial strictures limiting inflow or venous strictures limiting dilatation to a diameter sufficient for puncture (6-7 mm). Different situations may occur: --anastomotic or justa-anastomotic strictures with a normal arterial and venous, suggesting the fistulae should be reoperated (excepting the rare situation resulting from intrinsic compression due to a postoperative hematoma); --focal stricture which generally requires interventional radiology on both the arterial and venous sides; --arterial strictures with diffuse calcification, requiring a new arterial site; --insufficient drainage via the elbow or a small or absent cephalic and/or basilary vein.     

Circulation in neonates with intracranial arteriovenous fistula and cardiac failure

Two newborn infants with severe cardiac failure caused by a large cerebral arteriovenous communication were studied with complete cardiac catheterization, indicator-dilution curves and angiography. In one infant, studied at age 10 hours, a large right to left shunt through the patent ductus was seen with retrograde aortic flow into the left carotid artery. The entire flow in the descending aorta was supplied from the ductus. The second infant, studied at age 5 days, had a 20 percent right to left shunt through the foramen ovale and the ductus was closed. Hypoxia was caused by inadequate oxygenation of pulmonary venous blood, atrial right to left shunting and possibly ductal right to left shunting. The hemodynamic findings in cases of cerebral arteriovenous fistula would seem to depend on the patient's age at the time the studies are carried out and the severity of the lesion. Cardiac output was more than twice the normal value and blood flow through the arteriovenous fistula was probably greater than 4 liters/min per m².     

Surgical Improvement of Hepatic Venous Mixing to Resolve Systemic Arterial Hypoxemia Associated with Post-Fontan Pulmonary Arteriovenous Fistulae

Pulmonary arteriovenous fistulae are known to develop in patients who have functional single-ventricle heart disease and interruption of the inferior vena cava with direct hepatic drainage to the heart, in which a bidirectional Glenn shunt is the only source of pulmonary blood flow. The progressive systemic arterial hypoxemia that is associated with pulmonary arteriovenous fistulae can have important clinical consequences. Baffling the hepatic venous return to the pulmonary circulation can alleviate pulmonary arteriovenous fistulae.Herein, we present the case of a 13-year-old patient with modified Fontan anatomy and pulmonary arteriovenous fistulae, in whom redirection of a previously placed hepatic venous-to-right pulmonary artery conduit was required in order to increase systemic arterial oxygen saturation. Revision of the conduit improved mixing of hepatic venous effluent with blood flow from the bidirectional Glenn shunt. Three years after this revision, the patient''s oxygen saturation remained stable at 90%, and his physical activity was markedly improved. We present our rationale for selected redirection of the conduit and discuss other surgical options that can improve hypoxemia that is associated with pulmonary arteriovenous fistulae.Key words: Arteriovenous fistula/physiopathology/surgery, arteriovenous malformations/etiology/surgery, Fontan procedure/adverse effects/methods, heart defects, congenital/surgery, hepatic veins/physiology/surgery, postoperative complications/etiology/physiopathology/surgery, vena cava, inferior/abnormalities/surgery, pulmonary artery/surgery, regional blood flow/physiology, reoperationPulmonary arteriovenous fistula (PAVF) can develop in patients who have undergone placement of a bidirectional Glenn shunt for single-ventricle heart disease that is associated with interruption of the inferior vena cava (IVC) and direct hepatic venous drainage to the heart.^1,2 The progressive systemic arterial hypoxemia that is associated with PAVF can have important clinical manifestations. It has been reported that baffling hepatic venous return to the pulmonary circulation can alleviate PAVF. Here, we present and discuss the case of a 13-year-old modified-Fontan patient with PAVF, in whom redirection of a previously placed hepatic venous-to-right pulmonary artery (PA) conduit was required in order to overcome unfavorable streaming and to increase systemic arterial oxygen saturation levels.     

Surgical Treatment for a Complex Congenital Arteriovenous Malformation of the Lower Limb

Arteriovenous fistula is defined as an abnormal communication between the arterial and venous systems. The complexity of congenital arteriovenous malformations makes treatment challenging. We present the case of a 23-year-old woman who had a complex congenital arteriovenous malformation in her left leg and a history of 2 unsuccessful coil-embolization procedures. We ligated all the feeding arteries of the arteriovenous malformation in the region of the superficial femoral artery, and the surgery was successful without sequelae. The patient returned 2 years later with thrombosis of the great saphenous vein and underwent a second operation. The thrombosed vein and all varicosities were excised successfully.Surgery can be an effective method for correcting complex congenital arteriovenous malformations, especially in the lower limbs. A 2-staged surgical approach like ours might be a good option in suitable patients.Key words: Arteriovenous fistula/surgery, arteriovenous malformations/diagnosis/surgery, blood vessels/abnormalities, femoral artery/surgery, leg/blood supply, treatment outcomeArteriovenous fistula has been defined as an abnormal communication between a high-pressure, high-resistance arterial system and a low-pressure, low-resistance, high-capacity venous system.¹ The congenital and acquired forms of arteriovenous fistula are similar, in principle, from a hemodynamic point of view; however, the anatomy of the congenital fistula is typically far more complex. Instead of one major arteriovenous communication, there are usually many small, and frequently innumerable, connections in parallel array. As a result, the cardiac and ischemic effects of congenital arteriovenous malformations are usually less severe than those in acquired forms, and local effects such as venous hypertension, secondary varicosities, and limb hypertrophy predominate.²     

Neck Mass Caused by Spontaneous Arteriovenous Fistula of the Superior Thyroid Artery to its Homonymic Accompanying Vein by Duplex Ultrasonography

An arteriovenous (AV) fistula is an abnormal connection between an artery and vein. It is usually caused by congenital and acquired factors. A 65-year-old man presented to us with a neck mass of 4-year duration with no traumatic history. A Doppler study of the mass revealed a ‘whirlpool’ pattern in a cavity, and something resembling a thrombus adherent to the cavity wall. Based on the spectrum of blood flow, we strongly suspected a fistula. Digital subtraction angiography (DSA) was carried out to validate that the neck mass was caused by an AV fistula from the superior thyroid artery (STA) to the superior thyroid vein (STV).