256层iCT全景血管成像评价上肢动静脉内瘘功能不全

Evaluation of upper extremity arteriovenous fistula in hemodialysis patients by 256 slices iCT angiography

目的:探讨256层iCT全景血管成像在评估血液透析患者自体内瘘血管功能不全中的价值。方法:36例血液透析并血管通路功能不全患者采用256层iCT进行造瘘侧上肢血管成像,采用对比剂追踪及智能触发扫描技术,对原始图像采用容积再现(VR)、最大密度投影(MIP)、曲面重组(CPR)等技术进行后处理,获取内瘘血管的二维及三维图像。结果:36例患者均顺利完成CT血管成像检查,能清晰显示内瘘血管全程,内瘘血管并发症,病变部位、范围、狭窄程度及侧支循环形成情况。36例患者中单纯流入性动脉狭窄4例,其中多发节段性狭窄2例;单纯吻合口狭窄7例;单纯流出性静脉狭窄6例;流入性动脉+吻合口狭窄6例,吻合口+流出性静脉狭窄6例,流入性动脉+吻合口+流出性静脉狭窄4例,流入性动脉+流出性静脉狭窄3例。36例患者中合并附壁血栓16例,引流静脉瘤样变或节段性扩长、扩张8例,串珠样改变4例,9例患肢软组织肿胀伴发不同程度侧支循环形成。结论:全景CTA可以清晰显示瘘血管全程,能对内瘘血管的并发症进行准确诊断,为临床治疗提供指导。

Objective：To study the clinical value of 256 slices iCT angiography（CTA）in hemodialysis patients with upper extremity arterio-venous fistula dysfunction.Methods：36hemodialysis patients with vascular dysfunction had 256 slices iCT angiography to obtained the angiogram of the upper extremity arteriovenous fistula.Contrast material tracking and intelligent scanning technology were used.The raw data were post-processed with volume rendering（VR）,maximum intensity projection（MIP）,curved planar reformation（CPR）techniques,2Dand 3Dvascular images of the blood vessels with internal fistula were acquired.Results：CTA of 36 cases were performed successfully.The whole course of internal fistula,vascular complication,location and extent,degree of stenosis and collateral circulation were clearly displayed.Of the 36 patients,there were simple arterial inflow stenosis（4cases,including 2cases with multiple segmental stenoses）,anastomotic stenosis（7cases）,and simple outflow venous stenosis（6cases）.Moreover,arterial inflow in combination with anastomotic stenosis were revealed in 6cases,anastomotic stenosis plus outflow venous stenosis in 6cases,inflow arterial plus anastomotic and venous outflow stenosis in 4cases,arterial inflow and venous outflow stenosis in 3cases.Mural thrombus was found in 16 cases,venous aneurysm and segmental dilation in 8cases,bead-string like change in 4cases,soft tissue swelling in combination with various degree of collateral circulation in 9cases.Conclusion：The whole course of arterio-venous fistula can be displayed clearly on CTA,also vascular complications can be assessed accurately,which provides a valuable guidance for clinical treatment.