128排螺旋CT血管成像技术用于上肢动静脉内瘘中的影像特征分析及临床意义

Analysis of imaging characteristics and clinical significance of 128 slice spiral CT angiography in arteriovenous fistula of upper extremity

目的:探讨128排螺旋CT血管成像(CT angiography,CTA)技术在上肢动静脉内瘘中的应用价值并分析其影像学特征。方法:选取2020年7月—2022年10月期间到北京市海淀医院接受维持性血液透析治疗的80例慢性肾功能衰竭患者为研究对象,开展回顾性分析,所有患者均接受数字减影血管造影(digital subtraction angiography,DSA)及CTA检查,比较两种检查方式下对流入动脉、流出静脉、吻合口、侧支循环等血管通路狭窄程度的检出情况,统计不同检查方式患者并发症发生情况,并分析CTA下上肢动静脉内瘘的影像学特征。结果:经DSA检查,80例患者中的上肢动静脉内瘘狭窄检出率65.00%(52/80)与CTA检查的62.50%(50/80)比较差异无统计学意义(P>0.05),以吻合口狭窄最为常见;经DSA检查,患者的并发症发生率15.00%(12/80)高于CTA检查的5.00%(4/80),差异有统计学意义(P <0.05)。结论:通过实施CTA检查可实现对维持性血液透析患者上肢动静脉内瘘狭窄程度的有效诊断,通过观察CTA特征也可实现对动静脉内瘘功能的有效评估,对指导患者临床治疗有重要意义,且与DSA相比,CTA安全性更高,不易引发并发症。

Objective To investigate the value of 128 slice spiral CT angiography(CTA) in the diagnosis of arteriovenous fistulas in the upper extremity and analyze its imaging characteristics.Methods 80 patients with chronic renal failure who received maintenance hemodialysis in our hospital from July 2020 to October 2022 were selected as the study objects for retrospective analysis.All patients received digital subtraction angiography(DSA) and CTA examination,and compared the detection of stenosis degree of inflow arteries,outflow veins,anastomoses,collateral circulation and other vascular pathways under the two examination methods,The incidence of complications in patients with different examination methods was counted,and the imaging characteristics of arteriovenous fistula of upper limb under CTA were analyzed.Results Under DSA examination,the detection rate of arteriovenous fistula stenosis in upper limbs in 80 patients was 65.00%(52/80),which had no statistically significant difference from that of CTA examination [62.50%(50/80)](P> 0.05).After DSA examination,the complication rate of 15.00%(12/80) was higher than that of CTA examination [5.00%(4/80)],and the difference was statistically significant(P <0.05).Conclusion The implementation of CTA examination can effectively diagnose the stenosis degree of arteriovenous fistula in upper limbs of maintenance hemodialysis patients,and the observation of CTA imaging characteristics can also effectively evaluate the function of arteriovenous fistula,which is of great significance for guiding clinical treatment of patients.Compared with DSA,CTA is safer and less likely to cause complications.