血液透析之自体动静脉内瘘的CT血管造影初步研究

CT Angiography of Autogenous Arteriovenous Fistula for Hemodialysis: A Preliminary Report

目的:利用16层CT研究血液透析之自体动静脉内瘘的血管造影。材料和方法:慢性肾衰进行血液透析患者14例,2例肘部内瘘,其余均腕部标准内瘘。采用16层CT机,1mm×16方式,从非患肢前臂静脉进针,非离子型碘造影剂90ml,注射速度3ml/s,延时25～30s开始扫描,数据薄层重建采用低通滤过(FC01),层厚1mm,重建间隔0.8mm,分别完成容积显示、最大强度投影、多层面重建或曲面重建的CT血管造影(CTA)。结果:所有病例患肢血管在CTA上均得到良好显示,包括4例掌动脉弓良好显示。流入动脉均未见异常,前臂或肘部的引流静脉闭塞、中断6处,侧支循环明显;吻合口及其后的流出道狭窄19处,包括吻合口狭窄4处、吻合口后近处狭窄6处、其余各处狭窄8处,狭窄可为局限或细长。1例见头臂静脉支架内栓子形成。结论:CTA可以充分显示自体动静脉内瘘及其相关血管,有助于临床相关问题的解释和指导治疗。

Purpose： To evaiuate CT angiography of the autogenous arteriovenous fistula（AAF） for hemodialysis with a 16-slice scanner. Materials and Methods ： Seven chronic renal failure patients with hemodialysis were enclosed with 12 standard fistulas and 2 elbow fistula. CT angiography was undertaken with 1mm thickness, 0.8mm reconstruction interval, lowpass filter, and the reconstruction technique of volume rendering（VR）, maximum intensity projection（MIP）, and multiple/curved planar reconstruction（MPR or CPR）. A total of 90 ml of noniodinated iopamidol contrast material was administered at a rate of 3ml/sec into an antecubital vein of contralateral limb. Imaging commenced after a delay of 25-30seconds. Results：The vessels in diseased limb （including 4 arcus arteriosus manus） were clearly displayed on CTA. All of supplying artery were normal. Of the drainning veins, 6 occluded and collateral pathway generated at forearm and elbow, and 19 stenoses were found including 4 in the anastomoses, 6 in near-anasto-moses, and 8 in other sites. 1 thrombosis was revealed in the stent of brachiocephalic vein. Conclusion： CTA could reveal the autogenous AVF and its relationship, which might help clinical interpretation and treatment.