Depairon M, Ferrier C P, Tutta P, Descombes E, van Melle G, Wauters J P
Angiology, Hypertension and Vascular Medicine Division, University of Lausanne, Switzerland.
Vasa. 2001 Feb;30(1):53-8. doi: 10.1024/0301-1526.30.1.53.
Vascular access (VA) stenosis with subsequent thrombosis remains one of the major causes of morbidity and hospitalization in haemodialysis patients. The present cross-sectional study was planned in order to analyze the usefulness of brachial artery duplex ultrasound for detection and prediction of vascular access stenoses.
Color duplex ultrasound (Apogée Cx200, sectorial probe 7.5 MHz) was used to obtain the anatomical pattern of the VA and flow velocity waveforms of the brachial artery in 77 non-selected VA (47 Ciminio-Brescia fistulae and 30 PTFE grafts). In each VA, the resistance index (RI), the mean blood flow rate (Q) and the blood flow ratio index (QI) (QI = VA flow rate/contralateral flow rate) were calculated at the level of the brachial artery. The sensitivity and specificity of these brachial Doppler parameters were calculated for the detection of VA stenosis. In normal VA, positive (PPV) and negative predictive (NPV) values were calculated for the development of clinical stenotic complications 3 months post ultrasound examination.
Thirteen of the 77 VA (17%) were identified as stenosed by duplex ultrasound and confirmed by fistulography and/or during surgical exploration. The best screening tests for VA stenosis detection were a QI threshold < 4.0 with a sensitivity and specificity of 69 and 69% and an RI > 0.55 with a sensitivity and specificity of 62 and 66%, respectively. In the VA considered as normal by ultrasound, the prediction of subsequent stenosis within three months post-ultrasound examination gave a PPV of only 18% and 19% for RI and QI, respectively. NPV for RI and QI were 90% and 88%.
While Doppler ultrasound is a useful non-invasive test for the detection of prevalent VA stenosis, our results do not confirm that abnormal brachial Doppler flow parameters can predict short term development of VA stenosis.
血管通路（VA）狭窄及其继发的血栓形成仍然是血液透析患者发病和住院的主要原因之一。本横断面研究旨在分析肱动脉双功超声在检测和预测血管通路狭窄方面的实用性。
使用彩色双功超声（Apogée Cx200，7.5 MHz扇形探头）获取77例未选择的血管通路（47例Ciminio-Brescia动静脉内瘘和30例聚四氟乙烯移植物）的血管通路解剖结构和肱动脉血流速度波形。在每个血管通路中，于肱动脉水平计算阻力指数（RI）、平均血流率（Q）和血流比指数（QI）（QI = 血管通路血流率/对侧血流率）。计算这些肱动脉多普勒参数在检测血管通路狭窄方面的敏感性和特异性。在正常血管通路中，计算超声检查后3个月临床狭窄并发症发生情况的阳性预测值（PPV）和阴性预测值（NPV）。
77例血管通路中有13例（17%）经双功超声检测为狭窄，并经瘘管造影和/或手术探查证实。检测血管通路狭窄的最佳筛查试验为：QI阈值<4.0，敏感性和特异性分别为69%和69%；RI>0.55，敏感性和特异性分别为62%和66%。在超声检查认为正常的血管通路中，超声检查后3个月内对后续狭窄的预测，RI和QI的PPV分别仅为18%和19%。RI和QI的NPV分别为90%和88%。
虽然多普勒超声是检测普遍存在的血管通路狭窄的一种有用的非侵入性检查，但我们的结果并未证实肱动脉多普勒血流参数异常可预测血管通路狭窄的短期发展。
