64排螺旋CT血管成像技术对血液透析患者上肢动静脉内瘘血管的评价

Evaluation of Upper Extremity Arteriovenous Fistulas with 64-slice Spiral CT Angiography in Hemodialysis Patients

目的探讨64排螺旋CT血管成像技术(CTA)对血液透析患者上肢动静脉内瘘血管显示的临床应用价值。方法对41例行上肢血管造瘘术后需血液透析的慢性肾功能衰竭患者均使用64排螺旋CT CTA成像技术检查。对原始图像进行容积再现技术(VR)、最大密度投影(MIP)、曲面重组(CPR)等的后期处理,重组出二维和三维血管图像。结果 41例患者经64排螺旋CT扫描及血管三维重组均获得成功,能清楚地显示上肢动静脉内瘘血管及血管造瘘的部位,狭窄程度、部位及范围,无并发症发生。其中34例患者功能不全的造瘘血管中单纯流出静脉狭窄18例(15例吻合口近端静脉重度狭窄,狭窄远端静脉呈瘤样扩张,流出静脉近端呈串珠状狭窄;3例流出静脉近段呈串珠样狭窄和线样重度狭窄交替出现),吻合口+流出静脉狭窄6例,流入动脉+吻合口+流出静脉呈线性狭窄3例,吻合口狭窄4例,流入动脉狭窄3例(距吻合口约3 cm处桡动脉重度狭窄1例,锁骨下动脉狭窄2例)。7例为正常表现。结论 64排螺旋CT CTA技术可作为评价血液透析患者上肢内瘘血管的首选检查方法。

Objective To explore the clinical value of 64-slice spiral CT angiography in hemodialysis patients with upper extremity arteriovenous fistulas. Methods The 64-slice spiral CT angiography was performed in 41 chronic renal failure patients with upper extremity arteriovenous fistula for hemodialysis. Processed two-dimensional and three-dimensional vascular images included maximum intensity projection （MIP）, volume rendering （VR） and curved planar reconstruction （CPR）. Results The 64-slice spiral CT angiography and three-dimensional reconstruction were successfully carried out in all patients and clearly displayed fistula vessels, sites of fistula formation, stenosis degree, location and range. No complications occurred in all patients. Among 34 patients with fistula dysfunction, venous outflow stenosis was found in 18 （15 patients with severe proximal anastomotic stenosis, distal aneurysmal dilation and beaded stenosis of proximal outflow vein and 3 patients with alternate occurrence of beaded stenosis of proximal outflow vein and linear severe stenosis）, anastomotic stenosis and venous outflow stenosis in 6,arterial outflow stenosis, anastomotic stenosis and linear venous outflow stenosis in 3 ,anastomotic stenosis in 4, arterial outflow stenosis in 3 （1 patient with radial artery severe stenosis about 3 cm from anastomotie stoma and 2 patients with subclavian artery stenosis）, and normal performance in 7. Conclusion The 64-slice spiral CT angiography can be used as the preferred screening method for evaluating upper extremity arteriovenous fistulas in hemodialysis patients.