DSA iFlow彩色编码技术在人工血透通路腔内治疗中的应用研究

Application of i Flow color-coded imaging technology of digital subtraction angiography in the endovascular therapy of artificial hemodialysis pathway

目的探讨DSA iFlow彩色编码技术评估人工血液透析通路失功能血管腔内治疗效果的临床价值。方法收集深圳市人民医院2016年6月至2018年6月25例前臂人工血液透析通路失功能患者临床资料。所有患者均经影像学检查确诊为狭窄或闭塞性病变,并接受经皮腔内血管成形术(PTA)治疗。汇总所有患者DSA图像数据和多普勒超声监测数据,采用德国Siemens公司Artis Zeego DSA机Leonardo后处理工作站彩色编码技术iFlow软件对DSA图像进行后处理,获取相关参数:病变近端与远端密度达峰时间差值(ΔTTP)。基于DSA图像计算所有患者血透通路平均血流量(Q),并测量、计算管腔狭窄程度(S)。基于多普勒超声资料计算血流量(G)。配对t检验分析对比各患者术前、术后ΔTTP间、Q间、S间差异以及Q与G间差异,Pearson相关系数分析Q与S、ΔTTP间相关性。结果图像后处理和数据分析结果显示,PTA术后S比术前S明显减小(P<0.001),术后Q比术前Q明显增加(P<0.001);术前、术后ΔTTP间,Q与G间差异均有统计学意义(P<0.05);S与Q、ΔTTP与Q间均具有相关性,相关系数分别为-0.81、-0.65,P<0.001;Q与ΔTTP呈直线关系(t=-5.6,P<0.05),直线回归方程y′=834.36-318.01x(x≥0)。结论 DSA iFlow彩色编码成像技术获得的ΔTTP,为PTA术中实时有效地评估人工透析通路血流提供了一种新方法。

Objective To explore the clinical value of i Flow color-coded imaging technology in assessing the therapeutic effect of endovascular therapy for disfunction of artificial hemodialysis pathway.Methods The clinical data of a total of 25 patients with forearm disfunctioned artificial hemodialysis pathway, who were admitted to the Shenzhen Municipal People’s Hospital of China, were collected. All patients suffered from imaging-proved stenosis or occlusion lesions of artificial arteriovenous fistula and received percutaneous transluminal angioplasty(PTA) treatment. DSA imaging data and Doppler ultrasound monitoring data of all patients were collected. Using color-coded technology i Flow software(Artis Zeego angiography machine,Leonardo post-processing workstation, Siemens, Germany), the post-processing of DSA images were conducted, and the relevant parameters, i.e. the difference values of the time to reach peak density between the proximal site and distal site of lesion (ΔTTP), were obtained. Based on DSA images the mean blood flow of the hemodialysis pathway(Q) and the stenosis degree(S) in all patients were calculated, and based on the Doppler ultrasound data the blood flow(G) was calculated. Paired t-test analysis was used to compare the differences between preoperative ΔTTP, Q value and S value with postoperative ones, as well as between Q value and G value. Pearson linear correlation analysis was conducted to analyze the correlations between each other among Q value, S value and ΔTTP. Results Image post-processing and data analysis showed that the postoperative S value was significantly smaller than the preoperative S value(P<0.001), while the postoperative Q value was remarkably larger than the preoperative Q value(P<0.001). Postoperative ΔTTP, Q value and G value were significant different from the preoperative ones, the differences were statistically significant(P<0.05). Certain correlations existed between S value and Q value as well as between ΔTTP and Q value, and the correlation coefficients were-0.81 and-0.65 respectively(P<0.001). A linear correlation existed between Q value and ΔTTP(t=-5.6, P<0.05), and the linear regression equation was y′ =834.36-318.01 x(x≥0). Conclusion ΔTTP obtained from the i Flow color-coded imaging technology provides a new approach for real-time and effective assessment of blood flow within artificial dialysis pathway during the process of PTA.