超声监测人工动静脉内瘘及其并发症的应用价值

目的探讨彩色多普勒超声监测血液透析动静脉内瘘及其并发症的应用价值。方法选取59例患者进行自体动静脉内瘘血管系统彩色多普勒超声检查,总结15例并发症患者声像图特征及相关临床处理情况。结果 (1)44例动静脉内瘘患者血流通畅,血流量正常,透析充分。(2)15例检测出并发症:5例血栓形成导致通路血管闭塞或重度狭窄;2例内瘘狭窄;1例瘘旁形成血肿导致通路外压性狭窄;2例形成假性动脉瘤;1例形成桡动脉真性动脉瘤;2例回流静脉形成瘤样扩张;2例出现盗血综合征。(3)将并发症分为3种类型。Ⅰ类:内瘘废用,须改建(建立新的血管通路);Ⅱ类:须处理,在原血管通路基础上进行手术修复;Ⅲ类:无需处理,仅需观察。结论彩色多普勒超声监测动静脉内瘘及其并发症有很大临床价值。     

彩色多普勒超声检测动静脉内瘘狭窄的临床价值

目的研究彩色多普勒超声诊断自体动静脉内瘘狭窄的临床价值。方法对65例临床怀疑动静脉内瘘狭窄的患者进行相关血管超声检查,测量瘘口和上游动脉的峰值血流速度,计算两者比值。结果发现45例自体动静脉内瘘狭窄,血流速度比值≥2．5;其余20例患者未见明显狭窄,血流速度比值〈2．5。结论彩色多普勒超声检查是临床诊断动静脉内瘘狭窄的有效手段。     

彩色多普勒超声在自体动静脉内瘘血流量测量中的临床价值

目的 探讨彩色多普勒超声在自体动静脉内瘘患者血流量的测量价值。方法 选取动静脉内瘘手术的56例终末期肾病患者作为观察组，行上肢血管彩色多普勒超声检查和桡动脉-头静脉造瘘术，另纳入未进行彩色多普勒超声检查并已经行动静脉内瘘的50例终末期肾病患者作为对照组，根据内瘘成熟度评价标准，将观察组患者分为内瘘成熟组和内瘘不成熟组，对比两组的血管和血流情况。结果 内瘘成熟组肱动脉血流量、肱动脉内径、吻合口内径以及头静脉内经均明显大于内瘘不成熟组，差异均有统计学意义(P<0.05)。观察组并发症发生率为8.93%;对照组并发症发生率为24.00%,观察组并发症发生率明显低于对照组(P<0.05)。共有血管狭窄患者12例，经皮腔内血管成形术后患者狭窄处内径和肱动脉血流量明显大于术前，而峰值流速明显小于术前，差异均有统计学意义(P<0.05)。结论 彩色多普勒超声应用于术后测量血管和血流参数，评估内瘘成熟度术后可引导治疗血管狭窄。     

彩色多普勒超声在监测自体动静脉内瘘中的应用价值

目的探讨彩色多普勒超声对慢性肾功能衰竭患者自体动静脉内瘘的监测作用。方法应用彩色多普勒超声检查41例慢性肾功能衰竭患者动静脉内瘘的功能。结果 41例慢性肾功能衰竭患者17例动静脉内瘘血流通畅,血液透析量达标;24例出现并发症:局部血栓形成未完全闭塞4例(头静脉侧3例,瘘口处1例),完全闭塞9例(瘘口处闭塞7例,头静脉侧闭塞2例),栓塞后再通2例,狭窄6例(瘘口处狭窄5例,流出静脉狭窄1例),假性动脉瘤1例,静脉瘤样扩张2例。根据检查结果,采取相应的临床措施(内瘘重建术,溶栓等)取得满意的效果。结论彩色多普勒超声能够快速、准确地判断慢性肾功能衰竭患者动静脉内瘘的通畅情况,有无并发症,为临床及时治疗提供科学依据。     

超声对维持性血液透析动静脉瘘及管腔阻塞的诊断价值

目的：研究超声对维持性血液透析动静脉瘘（AVF）血流量不足及管腔阻塞的诊断价值。方法应用彩色多普勒超声对64例维持性血液透析并A V F血流量不足及管腔阻塞的患者进行检查。结果64例患者中45例为血流量不足,超声检查诊断1例为供血动脉狭窄,7例为吻合口狭窄,34例为引流静脉狭窄,3例为引流静脉有较大侧枝血管分流致血流量减少。另19例为管腔阻塞的患者,经超声检查3例为吻合口处血栓,14例为引流静脉血栓,2例为供血动脉血栓形成。结论超声对发现维持性血液透析患者AVF血流量减少及管腔阻塞,并进一步查找其原因,为及时适当治疗具有较大的临床指导意义。     

血液透析患者上肢动静脉内瘘狭窄或闭塞的介入治疗

目的探讨经皮球囊导管血管成形术治疗上肢动静脉内瘘狭窄和闭塞的疗效。方法14例上肢动静脉内瘘狭窄和闭塞的患者,对比术前和术后的临床表现、彩色多普勒超声、血透时血流量的改变及血管造影改变。结果所有病例经球囊扩张后,狭窄段明显扩张,闭塞处再通,经造影证实狭窄小于30%。结论球囊成形术是治疗动静脉内瘘狭窄和闭塞的有效方法,其操作简单、创伤小、安全、近期效果明显。     

彩色多普勒超声监测人工动-静脉内瘘的临床价值

目的探讨彩色多普勒超声对人工动静脉内瘘监测的临床价值。方法应用彩色多普勒超声对32例腕部桡动脉-头静脉人工动静脉内瘘进行术前监测和术后1周及6周的动态观察。结果经彩色多普勒超声监测的人工动静脉内瘘手术32例,30例成功,2例失败。结论彩色多普勒超声是监测人工动静脉内瘘血管通路的有效手段,可早期发现并发症等问题,及时进行处理。     

经皮血管成形术治疗血液透析动静脉内瘘狭窄或闭塞

目的:探讨经皮血管成形术(PTA)治疗血液透析患者动静脉内瘘狭窄和闭塞的临床效果。方法:对16例动静脉内瘘狭窄和闭塞的血液透析患者行PTA治疗,比较PTA治疗前后的血管造影表现、透析时血流量及静脉压的变化情况。结果:术后血管造影显示狭窄和闭塞的血管扩张、再通,触诊感血管震颤增强。术后第2天透析时血流量升高至200ml/min以上,可完成透析,在血流量为250ml/min时静脉压下降为(110.62±15.71)mmHg;其中2例分别在术后3个月和6个月发生再狭窄,再次行PTA后血流量恢复。所有患者均未出现血管破裂、出血、血栓形成等并发症。结论:PTA是治疗动静脉内瘘狭窄和闭塞的有效、安全、微创的方法,可选择适宜的患者采用。     

Percutaneous transluminal angioplasty for arteriovenous fistula stenosis or occlusion in hemodialysis patients

目的:探讨经皮血管成形术(PTA)治疗血液透析患者动静脉内瘘狭窄和闭塞的临床效果.方法:对16例动静脉内瘘狭窄和闭塞的血液透析患者行PTA治疗,比较PTA治疗前后的血管造影表现、透析时血流量及静脉压的变化情况.结果:术后血管造影显示狭窄和闭塞的血管扩张、再通,触诊感血管震颤增强.术后第2天透析时血流量升高至200ml/min以上,可完成透析,在血流量为250ml/min时静脉压下降为(110.62±15.71)mmHg；其中2例分别在术后3个月和6个月发生再狭窄,再次行PTA后血流量恢复.所有患者均未出现血管破裂、出血、血栓形成等并发症.结论:PTA是治疗动静脉内瘘狭窄和闭塞的有效、安全、微创的方法,可选择适宜的患者采用.     

多排螺旋CT血管造影评估血液透析患者自体动静脉内瘘功能不全

目的 探讨16排螺旋CT血管造影(CTA)对血液透析患者自体动静脉内瘘功能不全的价值.方法 21例自体动静脉内瘘功能不全的患者进行血管造影检查后,分别采用最大密度投影(MIP)和容积再现(VR) 技术对扫描的图像进行二、三维重建后处理,观察自体动静脉内瘘血管的成像情况.结果 21例患者病变血管成像清晰,显示单纯吻合口狭窄4例;流入动脉狭窄4例,其中多处狭窄3例;流出静脉狭窄7例,其中多处狭窄5例,伴有明显的静脉侧支循环4例;流入动脉及流出静脉同时狭窄2例;流入动脉、流出静脉及吻合口均狭窄2例;仅有动脉粥样斑块但无明显狭窄2例.本组合并附壁血栓6例,静脉瘤样扩张5例.结论 CTA评估血液透析患者自体动静脉内瘘功能不全,具有微创、能精准地显示内瘘血管的全貌和病变等优点.     

Postbiopsy renal allograft arteriovenous fistula: therapeutic embolization

Two patients with large, postbiopsy renal allograft arteriovenous fistulae are presented. One patient also had a renal artery anastomotic stenosis. Prominent clinical features in these cases were deterioration of allograft function and severe hypertension. Following therapeutic embolization, combined with balloon angioplasty in the second patient, there was marked improvement in allograft function and a return to normal blood pressure.     

Postbiopsy renal allograft arteriovenous fistula: Therapeutic embolization

Two patients with large, postbiopsy renal allograft arteriovenous fistulae are presented. One patient also had a renal artery anastomotic stenosis. Prominent clinical features in these cases were deterioration of allograft function and severe hypertension. Following therapeutic embolization, combined with balloon angioplasty in the second patient, there was marked improvement in allograft function and a return to normal blood pressure.     

前臂自体动静脉内瘘数字减影静脉造影方法分析

目的探讨前臂自体动静脉内瘘数字减影静脉造影(DSV)方法。方法2017年8月至2019年3月,对62例震颤减弱或无震颤低位自体动静脉内瘘通路进行DSV检查。检查中采用不阻断血流静脉顺行造影、阻断血流后动静脉容量灌注造影、保留对比剂旋转观察及释放止血带压力时血流恢复造影等多种方法。结果62例患者成功完成DSV检查,术中和术后均无明显并发症发生。其中动静脉瘘口完全闭塞5例(8%),前臂回流静脉主干血管闭塞12例(19%),主干不同程度狭窄45例(73%);伴有明显静脉瘤样扩张8例(13%),桡动脉狭窄12例(19%)。结论前臂自体动静脉内瘘DSV是一种安全、操作简单、结果可靠的检查方法。     

Ultrasound of renal transplantation

The most effective primary treatment of chronic renal failure is renal transplantation. A significant improvement in lifestyle and family life in conjunction with it being an extremely cost-effective procedure has resulted in an intense monitoring and imaging programme to help ensure a successful outcome. Ultrasound, both grey-scale and colour-flow Doppler, are useful monitoring techniques when interpreted in the clinical context, and in the delineation of peri-transplant collections, some of which can be drained under ultrasound guidance. After the early post-operative period it can also be utilized in the diagnosis of chronic vascular complications including transplant artery stenosis and arteriovenous fistula, although it is of limited use in the diagnosis of chronic rejection. This article will discuss the role of ultrasound in all its guises and how its efficacy in both the early transplant period in the monitoring of graft dysfunction and in the detection of the more chronic conditions including transplant artery stenosis and arteriovenous fistulae. A more limited role for ultrasound also exists in the long-term follow-up of patients and to aid the detection of complications including susceptibility to malignancy.     

经血管内栓塞治疗脑内动静脉瘘

本组报道了经血管内治疗３例脑内动静脉瘘。栓塞均经股动脉入路，采用微螺旋圈安置和可脱球囊技术将动静脉瘘口逐一闭塞。术后颅内杂音立即消失，临床证状显著改善。随访５个月至２年病情无复发，颅内吹风样杂音是诊断动静脉瘘的重要体征，在栓塞中挤压同侧或双侧颈总动脉可以降低瘘口的血流速度和压力，有益于栓塞成功。     

彩色多普勒超声对血液透析血管的评估价值探讨

目的 探讨血管超声对自体动静脉造瘘术前评估及术后随访的临床价值.方法 采用GE Vivid 7 Dimension彩色多普勒对50例患者进行上肢血管超声检查,其中拟行自体动静脉造瘘的患者30例,已造瘘患者20例,总结造瘘超声术前评估及术后随访结果,并制定超声对造瘘血管的评估标准.结果 ①术前评估血管中,桡动脉管壁弥漫性钙化2例,头静脉内径过细(1.4 mm)1例,均放弃桡动脉-头静脉造瘘,余者均成功行造瘘术;②20例造瘘术后随访患者,1例因静脉瘤样扩张并前臂明显水肿,2例因血栓形成使管腔明显狭窄,导致血流量不足.结论 通过血管超声对自体动静脉造瘘的术前评估及术后随访,可提高造瘘成功率,并及时发现造瘘术后的并发症,有很好的临床应用价值.     

肝癌介入术中动静脉瘘的评判与处理

目的 分析肝癌动静脉瘘(AVS)的DSA表现,寻找与其相适应的瘘口封堵方法,改善合并AVS 肝癌的治疗效果.方法 通过对637例患者中发现的183例AVS进行影像学分析,对轻度AVS患者在碘油栓塞后进行供血动脉栓塞,对中、重度患者先行瘘口处理,保证药物在肿瘤组织中的有效灌注与碘油在瘤组织中的良好沉积.结果 89例轻度AVS碘油栓塞后都能成功地进行肿瘤供血动脉的栓塞,94例中、重度患者中68.1%(64例)封堵后碘油得到良好或较好沉积,14.8%(13例)栓塞不完全,进行单纯化疗药物灌注,11.7%(11例)过度栓塞导致碘油沉积不满意,6.4%(6例)痿口过大或瘘口过于弥漫未能封堵.未发生严重并发症.结论 绝大多数肝癌伴AVS患者都能得到有效的瘘口封堵,改善了肝癌合并AVS的疗效,对瘘口的栓塞处理是安全、可靠的.     

Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage

We review seven patients with intracranial dural arteriovenous fistulae (ICDAVF), each altering the initial type of venous drainage to one with a higher grading during long-term follow-up. Five were discovered due to symptoms of intracranial hypertension, two due to changes in tinnitus and one case following subarachnoid haemorrhage. In five cases, cortical venous drainage developed during the follow-up period. Three different mechanisms were observed: stenosis or thrombosis in the draining veins in 4 cases: increased arterial flow in 2; and the appearance o a new fistula site or extension of the initial shunt in 2. Type I and type II a fistulae which are not completely cured, require both close clinical observation and Doppler examinations in the follow-up period. Any charge in the clinical pictures indicates a repeat angiogram. Stenosis of the venous drainage, forecasting later worsening in the venous outlet, requires more thorough angiographic follow-up. Received: 26 June 1995 Accepted: 16 February 1996