CT静脉造影在血透患者中心静脉狭窄或闭塞介入治疗中的价值

The application of CT venography in interventional treatment of central vein stenosis or occlusion in hemodialysis patients

目的探讨术前CT静脉造影对血液透析患者中心静脉狭窄或闭塞介入治疗的指导意义。方法 2007年7月至2010年8月收治临床怀疑中心静脉病变血透患者8例,均表现为不同程度内瘘侧上肢肿胀,皮温增高8例患行均行中心静脉介入治疗,术前行前臂及中心静脉CT造影,在轴位基础上行多平面重组、容积再现及最荡密度投影,重建并记录血管狭窄或闭塞部位、狭窄程度和范围。将CT静脉造影与DSA造影结果进行对比。结果术前CT静脉造影显示中心静脉狭窄3例(1例75%,2例90%),闭塞5例,其中左侧头臂静脉病变2例,在锁骨下病变1例,右头臂静脉病变4例,右锁骨下静脉病变1例:病变范围0.5～2.0 cm,平均1.2 cm,与DSA造影结果完全符合。结论 CT静脉造影可以准确显示中心静脉狭窄或闭塞部位、狭窄程度和范用,为球囊和支架的选择提供帮助。

Objective To discuss the guiding significance of CT venography in interventional treatment of central vein stenosis or occlusion in hemodialysis patients. Methods A total of 8 hemodialysis patients with suspected central vein stenosis or occlusion, who were admitted to the hospital during the period from July 2007 to Aug. 2010, were enrolled in this study. Clinically, the patients complained of affected-side upper limb swelling with higher skin temperature. Interventional treatment of the central vein was carried out in all 8 patients. Preoperative CT venography of the forearms and the central vein was performed. Multiplanar reconstruction （MPR）, volume rendering （VR） and maximum intensity projection （MIP） were employed to reconstruct and display the site, severity and extent of the stenosis or occlusion. The CT venography findings were compared with DSA results. Results Preoperative CT venography demonstrated central vein occlusion in one case and stenosis in 3 cases with a stenosis degree of 75% （n = 1） or 90% （n=2）. The lesions locations included left brachiocephalic vein （n = 2）, left subclavian vein （n = 1 ）, right braehioeephalic vein （n = 4） and right subclavian vein （n = 1 ）. The lesion＇s length was 0.5-2.0 cm, with a mean of 1.2 cm. The above findings of CT venography were totally consistent with DSA results. Conclusion CT venography can accurately display the location, severity and extent of the stenosis or occlusion of the central vein, which is very helpful for the operators to select proper balloon and stent. （J Intervent Radiol, 2012, 21： 465-468）