下肢静脉血栓合并动静脉瘘相关血管因素的初步研究

Preliminary study of vascular factors in venous thrombosis associated with arteriovenous fistula of lower limbs

目的:利用彩色多普勒对下肢静脉血栓合并动静脉瘘的相关因素进行分析。方法:回顾性分析2015年6月—2016年12月超声诊断的25例下肢静脉血栓合并动静脉瘘患者的资料,其中男12例,女13例,共涉及病变血管节段31段。记录患者发病部位、动静脉瘘病变血管节段血栓内的新生血管数量、内径及血栓内新生血管与外周小动脉血流阻力指数(Resistivity index,RI)。结果 :25例下肢静脉血栓合并动静脉瘘患者中,血流动力学改变均只局限在动静脉瘘病变节段血管范围内。肢体近心端静脉更容易发生血栓合并动静脉瘘。21(21/31)段动静脉瘘病变血管血栓内存在新生血管,新生血管数量为1.71±0.64,管径为(0.96±0.37)mm。其中14(14/21)段可以清晰显示静脉外周小动脉,动静脉瘘病变血管内新生血管和外周小动脉的RI分别为0.49±0.07和0.67±0.06,两者之间存在统计学差异(P<0.01)。10(10/31)段动静脉瘘病变血管未发现血栓内新生血管。结论:下肢近心端肢体更容易发生静脉血栓合并动静脉瘘,且动静脉瘘不易引起广泛肢体静脉血流动力学改变。部分血栓内新生血管直接参与下肢静脉血栓合并动静脉瘘的形成。

Objective： Analysis of related factors of lower extremity venous thrombosis complicated with arteriovenous fis-tula by color Doppler ultrasound. Methods： We retrospectively analyzed 25 patients of lower extremity venous thrombosis complicated with arteriovenous fistula from June 2015 to December 2016, which diagnosed by ultrasound, 12 cases of male, 13 cases of female, and involved a total of 31 segmental vascular lesions. Recording the location of the venous thrombuosis with arteriovenous fistula, the number, internal diameter and RI of the neovascularization in the thrombosis of the arteriovenous fistula vascular segmental. Results： Hemodynamic changes were only existed in the vascular segment of arteriovenous fistula in 25 cases which with lower extremity venous thrombosis complicated with arteriovenous fistula. The incidence of venous throm-bosis complicated with arteriovenous fistula was higher in proximal vascular, 21 （21/31） segments of arteriovenous fistula with venous thrombosis exist neovascularization in the thrombosis, the number of the new vessels was 1.71±0.64, the internal diam-eter of the new vessels was （0.96±0.37） mm. Fourteen （14/21） segments can clearly show the peripheral arteries of the lesion. The RI of the neovascular of the arteriovenous fistula and the peripheral arterioles in the lesions were 0.49 ±0.07 and 0.67 ± 0.06. There was a significant difference between them（P〈0.01）. The blood flow direction was from high resistance to low resis-tance. Ten （10/31） segments have no neovascular in the venous thrombosis complicated with arteriovenous fistula. Conclusions：The proximal extremity of the lower limb is more likely to have venous thrombosis, arteriovenous fistula is not easy to cause extensive changes in limb venous hemodynamics. Some of the new vessels are directly involved formation of the arteriovenous fistula in the lower extremity venous thrombosis.