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目的对应用动静脉内瘘作为永久性血管通路的维持性血液透析患者在内瘘功能障碍时应用CT血管成像技术进行判断和影像学评价,探讨CT血管成像技术在该领域的应用价值。方法对23例自体动静脉内瘘功能障碍的尿毒症患者,应用64排螺旋CT血管成像技术进行检查,同时采用彩色多普勒超声作为对照,观察内瘘血管的狭窄部位、程度、血栓形成及侧支循环情况,并对两种主要的后处理方法进行对比。结果 23例患者均经血管成像技术明确瘘管病变的部位。流入动脉狭窄3例,其中轻度1例,中度1例,重度1例;流出静脉狭窄12例,轻、中及重度分别为4例、5例及3例,其中伴有血栓形成1例;吻合口狭窄12例;出现侧支循环3例,2例伴有上肢肿胀,CT血管成像技术和超声比较,在动脉狭窄、流出道狭窄、血栓形成方面完全吻合;对于内瘘功能障碍并发整个上肢肿胀者超声无法详细描述中心静脉情况,CT能详细描述锁骨下静脉、头臂干、上腔静脉是否有狭窄或血栓形成;超声更方便监测提供吻合口、动脉狭窄处、流出道狭窄处的血管内径。结论自体动静脉内瘘发生功能障碍时,超声应作为首选的临床检查手段,但内瘘功能障碍并发整个上肢肿胀时,64层螺旋CT血管成像技术可对手术干预提供更有价值的帮助。
Objective To evaluate CT angiography and imaging evaluation of patients with maintenance hemodialysis who use arteriovenous fistula as a permanent vascular access in fistula dysfunction and to explore the value of CT angiography in this field. Methods Twenty-three patients with uremia with autologous arteriovenous fistula dysfunction were examined with 64-slice spiral CT angiography and color Doppler ultrasound was used as control to observe the location, degree, thrombosis, Collateral circulation, and compare the two main post-treatment methods. Results All the 23 patients were confirmed by angiography. Inflow into the artery stenosis in 3 cases, of which mild in 1 case, moderate in 1 case, severe in 1 case; Outflow vein stenosis in 12 cases, light, moderate and severe were 4 cases, 5 cases and 3 cases, of which 1 case of thrombosis ; Anastomotic stenosis in 12 cases; collateral circulation occurred in 3 cases, 2 cases accompanied by upper limb swelling, CT angiography and ultrasound comparison in arterial stenosis, outflow tract stricture, thrombosis completely consistent; fistula dysfunction complicated by the entire Upper limb swab ultrasound can not describe in detail the central venous situation, CT can be described in detail the subclavian vein, brachiocephalic, superior vena cava stenosis or thrombosis; ultrasound is more convenient to monitor provide anastomosis, artery stenosis, outflow tract stenosis Blood vessel diameter. Conclusion Ultrasound should be the first choice of clinical examination when dysfunction of arteriovenous fistula occurs. However, 64-slice spiral CT angiography can provide more valuable help for surgical intervention when fistula dysfunction is accompanied by swelling of the whole upper extremity.