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目的探讨CO2血管造影在血液透析的血管通路评价中的应用技术及其价值。方法对10例慢性肾衰经桡动脉内瘘进行血液透析的患者进行CO2静脉造影,7例于内瘘远侧手背静脉穿刺,3例直接行内瘘穿刺,快速推注CO2每次40～60ml,完成到上腔静脉的全程引流静脉造影,并于肘部加压后完成1次前臂静脉造影。使用ToshibaInfinixVc i旋转DSA机,直接以减影模式实时显示,并对图像作叠加处理。结果所有病人均顺利安全地完成检查,静脉表现为流畅连续的管状结构或显示为一连串气泡,7例手背静脉进针中仅1例清晰显示粗大的引流头静脉,其余显示了较多旁支;3例经内瘘直接进针,均清晰显示引流的头静脉,旁支稀少。5例手背静脉进针加压后造影显示2例头静脉发生变化,其余未见明显变化。所有上臂段头静脉,以及腋静脉、锁骨下静脉均显示较清晰,叠加后图像更好地显示了连续流畅的血管。结论血管通路CO2静脉造影是安全经济和快速有效的手段;肾衰病人血管通路引流静脉有其自身特点,内瘘直接穿刺造影是引流静脉造影的最佳途径,充分利用各种技巧能够更好地显示靶血管及其病变。
Objective To explore the application and value of CO2 angiography in the evaluation of vascular access in hemodialysis. Methods Ten patients with chronic renal failure who underwent hemodialysis by radial arterial fistula were subjected to CO2 venography. Seven cases were punctured by the dorsal vein of distal fistula and three were directly punctured by internal fistula. The rapid CO2 injection was performed every 40-60 ml. Complete the entire superior vena cava venography, and in the elbow to complete a forearm vein pressure after angiography. Use the ToshibaInfinixVc i rotating DSA machine, direct subtraction mode display in real time, and the image overlay. Results All patients underwent successful and safe examinations. The veins showed a smooth and continuous tubular structure or a series of bubbles. Only one of the seven cases of the dorsal venous needle clearly showed a thick dural vein and the rest showed more collateral. Cases directly into the needle through the fistula, are clearly show the drainage of the first vein, sparsely branched. 5 cases of hand dorsal venous needle compression after angiography showed two cases of head vein changes, the other no significant change. All of the upper arm segment cephalic veins, as well as the axillary and subclavian veins, were shown to be sharper and the superimposed images showed a much better continuum of blood vessels. Conclusion Vascular access CO2 venography is a safe, economical and effective means of rapid and effective. Drainage veins of patients with renal failure have their own characteristics. Direct fistulography of internal fistula is the best way to drain venography. Taking full advantage of various techniques can better Shows the target vessel and its lesions.