彩色多普勒超声评价自体动静脉内瘘急性血栓形成中用Fogarty球囊导管取栓的临床应用

Application value of color Doppler ultrasonography in autologous arteriovenous fistulas,arteriovenous and acute thrombosis with Fogarty catheter embolectomy

目的探讨彩色多普勒超声在评价慢性肾功能衰竭尿毒症患者自体动静脉内瘘失功后急性血栓形成及其在Fogarty球囊导管取栓术前后的临床应用价值。方法回顾性分析133例慢性肾功能衰竭尿毒症自体动静脉内瘘急性血栓形成患者采用Fogarty球囊导管的取栓情况,术前彩色多普勒超声确定血栓的部位、范围及性质,术后复查并监测血管通路情况。结果 133例Fogarty球囊导管取栓患者,彩色多普勒超声诊断22例桡动脉血栓,72例头静脉血栓,39例桡动脉、吻合口附近或多处血栓。Fogarty球囊导管取栓术后1 d复查彩色多普勒超声发现117例患者取栓术后动静脉内瘘恢复通畅,16例管腔内存在血栓,未见血流通过。对16例仍存在血栓患者中的11例进行二次取栓,术后1 d再次复查超声示血流通畅,未见血栓回声;另3例行内瘘重建术,2例放弃手术。Fogarty球囊导管取栓术后3个月随访内瘘均满足血液透析。结论彩色多普勒超声能够快速、准确地判断动静脉内瘘血栓的部位和范围,为临床Fogarty球囊导管取栓提供可靠依据,提高手术成功率,减少并发症,是术前、术后不可缺少的检查手段。

Objective To explore the application value of color Doppler ultrasound in chronic renal failure in autologous arteriovenous fistulas,arteriovenous and acute thrombosis before and after Fogarty catheter embolectomy. Methods The retrospective analysis was performed on 133 patients with chronic renal failure（CRF） and autologous arteriovenous fistulas,arteriovenous and acute thrombosis. CDFI was used to confirm the position of emboli and the diameter of the vena cava before the operation, observe and monitor the vascular access after the operation. Results A total of 133 patients underwent color Doppler sonography before Fogarty catheter embolectomy, including 22 cases with radial artery thrombosis,72 cases with cephalic vein thrombosis and 39 cases with near the radial artery anastomosis or multiple thrombosis as diagnosed by CDFI. Fistulas restoring patency was found in 117 of the 133 cases on the 1st day after operation,and thrombosis in blood vessel in 16 cases. And 11 of 16 cases underwent the second surgery, and then the blood flow was restored as verified by CDFI on the 1st day after operation. The other 3 cases underwent fistula reconstruction and 2 cases gave up surgical operation. Three months after Fogarty catheter embolectomy, fistulas was appropriate for hemodialysis.Conclusion CDFI can quickly and accurately judge the location and extent of thrombosis in the arteriovenous fistulas and provide the scientific basis for Fogarty catheter embolectomy in clinic, which is an indispensable means for the pre-and postoperation.