动脉穿刺自体动静脉内瘘造影评价血管透析通路

Angiography of autogenous arteriovenous fistula vai arterial puncture for the evaluation of hemodialysis pathway

目的应用静脉留置针直接动脉端顺行穿刺的方法行自体动静脉内瘘血管造影，评估血透患者的血管通路狭窄情况，为临床手术重建内瘘功能或经皮腔内血管成形术（PTA）提供正确的术前影像指导。方法采用西门子Artisu中型C臂机对46例临床自体动静脉内瘘流量不佳的维持性血透患者进行检查，穿刺针选用BDIntimaII20G或22G密闭式静脉留置针，在内瘘动脉端顺穿成功后，经高压注射器注入非离子型对比剂安射力，速率1～1．5ml／s，对比剂总量约2～5ml，造影图像采集为4帧／s。结果46例患者均顺利完成检查，无任何并发症发生。所有患者均获得满意的内瘘造影图像，包括动脉流人道、吻合口和静脉流出道等影像，血管狭窄程度、长度、部位均得到清晰显示。其中内瘘吻合口狭窄2例；桡动脉流人道狭窄伴头静脉流出道狭窄5例；头静脉流出道狭窄37例，内瘘吻合口狭窄伴静脉流出道狭窄1例，桡动脉流人道闭塞伴内瘘侧枝循环形成1例。结论采用静脉留置针在内瘘动脉端顺穿的方法行内瘘血管造影检查，具有操作简便、微创、患者易接受、可重复性好、对比剂用量少、图像清晰、动态显示等的优点，尤其是对患者的残余。肾功能保护十分有利，能准确评估患者的透析血管通路情况，为临床治疗提供指导。

Objective By use of direct arterial end antegrade puncture with vein indwelling needle, we pertormed the an- giography of autogenous arteriovenous fistula so as to evaluate the narrowed degree of hemodialysis pathway as well as to offer the preoperative imaging guidance for the reconstruction of internal fistula function and pereutaneous transluminal angioplasty （PTA）. Methods Siemens Artis U was used to examine the patients with internal fistula, who were required for sustaining hemodialysis. The needle was BD Intima II 20G or 22G; After successfully punctured into internal fistula, non ionized iodine contrast material was injected at the rate of 1- 1.5 ml/sec （totally volume 2-5 ml） under high pressure in jector, with 4 frame/sec. Results 46 patients were all successfully completed inspection, without any occurrence of com plications. All patients showed satisfactory internal fistula angiographic images, that is, certain items, including arterial inflow and venous outflow tract, anastomotic stenosis, imaging, length, position, which were clearly displayed. In this work, anastomotie stenosis was found in 2 cases, radial artery inflow tract stenosis with cephalic venous outflow tract ste- nosis in 5 cases, cephalic venous outflow tract stenosis in 37 cases, and anastomotic stenosis and fistula venous outflow tract stenosis in 1 case, and the radial artery inflow occlusion collateral circulation with fistula formation in 1 case. Conclu- sion Puncture through the skin radial artery （brachial artery） has great clinical significance in evaluating the hemodialysis pathway, especially for artery inflow tract, anastomotic and outflow tract of vein, because it is able to use a little of con- trast material, to provide clearly picture, to display dynamically, and to be less invasive. Moreover, this procedure is best for protecting RRF and can evaluate the internal fistula objectively and exactly, thereby providing the guidance to clinical treatment.