多普勒超声对创伤性动静脉瘘的诊断及鉴别诊断

Diagnosis and differential diagnosis of Doppler ultrasonography in traumatic arteriovenous fistula

目的 探讨创伤性动静脉瘘的彩色及频谱多普勒特征及其鉴别诊断。方法 回顾性分析11 例动静脉瘘患者,使用彩色超声诊断仪观察瘘口处血流情况,受累血管的内径、形态、血流性质及方向,对 瘘口处及受累血管血流频谱进行分析,并与健侧对照。结果 8例可直接显示瘘口,显示受累血管管壁连 续性中断,瘘口处五彩镶嵌样血流自动脉流向扩张的静脉腔,脉冲多普勒示瘘口处呈双期单向连续性频 谱,血流速度300～390cm/s,受累动脉近心端血流为高速低阻型,受累静脉出现脉动样血流,近心端静脉 呈高速低阻型频谱;4例患者远心端静脉内出现逆向离心性血流。结论 瘘口处双期单向分流,静脉出现 高速、动脉样血流频谱是动静脉瘘的特征性表现,多普勒超声对创伤性动静脉瘘能够正确诊断及鉴别诊断。

Objective To observe characteristic imaging of traumatic arteriovenous fistulas(TAVF) and to evaluate the methods of differential diagnosis of TAVF by Doppler ultrasonography. Methods Eleven patients suffering from TAVF were selected to have the examination of Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow character of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Localization of arteriovenous fistulas was observed directly in eight patients, which presented as intercepted wall of the affected vessels and irregular mosaic flashes flowing towards enlarged vein from artery. Pulsed wave Doppler showed unilateral continuant spectral with maximum velocity 300-390 cm/s when sampled in the fistula. Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance. Arterialized flow pattern was observed in affected veins. Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance. Reversed centrifugal blood flow was observed in the distal veins of the fistulas in 4 cases. Conclusions Unilateral shunt in both diastole and systole in the fistula and arterialized flow with high velocity in veins are characteristic presentation of TAVF. Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of TAVF.