CTA在血液透析患者上肢动静脉内瘘功能不良评估中的价值  

The Value of CTA in the Evaluation of Upper Limb Arteriovenous Fistula Dysfunction in Hemodialysis Patients

作　　者：陈晟[1] 张小胜[2] 王勋[1] 陈琦[1] 朱永洁 CHEN Sheng;ZHANG Xiaosheng;WANG Xun;CHEN Qi;ZHU Yongjie(Department of Radiology,Kunshan Third People’s Hospital,Kunshan 215300,China;Department of Radiology,Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine)

机构地区：[1]昆山市第三人民医院放射科,昆山215300 [2]江苏省中西医结合医院放射科

出　　处：《中国医学计算机成像杂志》2022年第4期402-406,共5页Chinese Computed Medical Imaging

摘　　要：目的:研究血液透析患者应用CT血管成像(CTA)评估上肢动静脉内瘘(AVF)功能不良的诊断价值。方法:选取2018年5月—2021年2月期间在本院及江苏省中西医结合医院行血液透析治疗的162例因上肢动静脉内瘘功能不良行CTA检查患者为研究对象,回顾性分析患者临床资料。所有患者均行CTA检查,分析患者透析通路特征及CTA检查结果。结果:162例CTA检查共见狭窄病变290处,其中局限性狭窄172处(59.31%),节段性狭窄118处(40.69%)。上肢AVF位于前臂的138例患者中共见260处狭窄病变,其中近吻合口动脉狭窄17处(6.54%),吻合口狭窄47处(18.08%),近吻合口静脉狭窄132处(50.77%),流出道狭窄64处(24.62%);吻合口与狭窄远心端距离介于3~5cm共47处(18.08%),5~10cm共14处(5.38%),>10cm共3处(1.15%)。上肢AVF位于上臂的24例患者中共见30处狭窄病变,其中近吻合口狭窄20处(66.67%),流出道狭窄10处(33.33);吻合口与狭窄远心端距离介于3~5cm共3处(10.00%),5~10cm共7处(23.33%)。血管狭窄程度25%~50%34例(20.99%),50%~75%84例(51.85%),>75%44例(27.16%)。结论:血液透析患者行CTA检查,可对上肢AVF功能不良的内瘘血管狭窄数量、部位及程度进行准确评估,为手术治疗提供可靠依据。Purpose:To study the diagnostic value of CT angiography(CTA)in evaluating upper limb arteriovenous fistula(AVF)dysfunction in hemodialysis patients.Methods:A total of 162 patients who underwent hemodialysis in our hospital and Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine from May 2018 to February 2021 who underwent CTA examination due to dysfunction of upper extremity AVF were selected as the research objects.The clinical and CTA data of the patients were retrospectively analyzed.Results:A total of 290 stenosis lesions were found in 162 cases of CTA examinations,of which 172(59.31%)were localized stenosis,and 118(40.69%)were segmental stenosis.In 138 cases of upper limb AVF located in the forearm,a total of260 stenosis lesions were shown.There were 17(6.54%)near anastomotic artery stenosis,47(18.08%)anastomotic stenosis,132(50.77%)near anastomotic vein stenosis,and 64(24.62%)outflow tract stenosis.The distance between the anastomosis and the distal end of the stenosis was from 3 cm to 5 cm in 47 sites(18.08%),from 5 cm to 10 cm in14 sites(5.38%),>10 cm in 3 sites(1.15%);24 cases of upper limb AVF located in the upper arm,30 stenosis lesions were seen in 24 patients,and 20(66.67%)of them were near anastomotic stenosis,10(33.33)were outflow tract stenosis,of which the distance between the anastomosis and the distal end of the stenosis was 3-5 cm in 3 sites(10.00%),and 5-10 cm in 7(23.33%).The degree of vascular stenosis was 25%-50%in 34 cases(20.99%),and 50%-75%in 84 cases(51.85%),>75%in 44 cases(27.16%).Conclusion:CTA examination for hemodialysis patients can be used to accurately assess the number,location and degree of stenosis of internal fistula vessels with dysfunctional AVF of the upper limbs,and provide a reliable basis for surgical treatment.

关 键 词：CT血管成像 血液透析 动静脉内瘘 功能不良 上肢 

分 类 号：R445.2[医药卫生—影像医学与核医学]