超声对血液透析造瘘术前血管的观察和评价

Ultrasound Evaluation of the Vessels for Arteriovenous Fistula Formation for Haemodialysis

目的:探讨血液透析动静脉造瘘术前应用超声评价相关血管的手术可行性的价值。材料和方法:采用AccuvixXQ彩色多普勒对34例拟行自体动静脉造瘘的患者行相关血管超声检查。结合30例患者的手术结果,总结其超声术前评价标准。结果:(1)4例放弃手术中,锁骨下动脉和腋动脉显著狭窄2例,桡动脉管壁钙化1例,头静脉内径过细(1.2mm)及位置过深1例。(2)30例行造瘘手术。其中,27例造瘘成功,3例失败;失败原因为血栓形成2例,血流量不足1例,无法满足透析。(3)超声术前评价标准:①供血动脉及回流静脉系统无显著狭窄或闭塞;②桡动脉内径>1.6mm,反应性充血充分,管壁无明显形态学改变;③头静脉内径≥2.5mm(应用止血带),位置须表浅平直,无多条分支。结论:通过血管超声检查声像图表现及术前评价标准选择适合造瘘患者,特别对常规检查困难或不确定者,有很好的临床应用价值。

Purpose The aim of the study was evaluate the vessels for arteriovenous fistula formation on haemodialysis patients using ultrasound. Materials and Methods Vascular ultrasound was performed in 34 candidates for internal arteriovenous fistula operation （AVF）. 30 of them were corrected by the operations. The ultrasound criteria were retrospectively analyzed. Results AVF operations were aborted in 4 subjects due to significant stenosis of subcalvical artery or axillary artery on 2 patients,radial artery wall calcification on one patient and abnormal diameter of cephalic vein （1.2mm）on one patient. The other 30cases had successful AVF operation. But 3 cases failed because of thrombosis （n=2） and insufficient flow （n=1）. The inclusion criteria for AVF operation are：①no significant stenosis or occlusion in the feeding artery and draining vein,②radial artery internal diameter1.6mm with no wall morphology change and normal hyperaemic response,and ③the diameter of cephalic vein≥2.5mm in superficial position and no collateral branches when a tourniquet was applied. Conclusions Vascular ultrasound was of value in selection of the candidates for internal AVF operation,especially in those with inconclusive physical examination.