Asif Arif, Ravani Pietro, Roy-Chaudhury Prabir, Spergel Lawrence M, Besarab Anatole
Division of Nephrology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida 3136, USA.
J Nephrol. 2007 May-Jun;20(3):299-303.
At present, an arteriovenous fistula is the best available access when compared with an arteriovenous graft or a tunneled hemodialysis catheter. Preoperative vascular mapping has been shown to result in an increased placement of arteriovenous fistulae. In general, 3 modalities (physical examination, ultrasound examination and angiographic evaluation) are available for vascular evaluation. Both arterial as well as venous examination can be conducted using physical examination. However, this technique is known to miss veins, especially in the obese, and result in exclusion of patients who do not show adequate veins on clinical inspection, but who have suitable veins (proven by the other modalities) for AVF construction. Ultrasound examination of the vessels is an objective assessment. It provides an excellent evaluation of both arteries and veins for creation of an arteriovenous fistula. The technique is limited by its inability to directly visualize the central veins. Although imaging of the veins by the administration of radiocontrast dye optimally visualizes peripheral as well as central veins, it exposes the patient to the risk of radiocontrast-induced nephropathy. This article presents advantages and disadvantages of the 3 mapping techniques and proposes a strategy to conduct vascular mapping in patients with chronic kidney disease.
目前，与动静脉移植物或带隧道的血液透析导管相比，动静脉内瘘是现有的最佳血管通路。术前血管造影已被证明可增加动静脉内瘘的建立。一般来说，有三种方法（体格检查、超声检查和血管造影评估）可用于血管评估。动脉和静脉检查都可以通过体格检查进行。然而，已知这种技术会遗漏静脉，尤其是在肥胖患者中，并且会导致那些在临床检查中未显示出足够静脉，但有适合建立动静脉内瘘的静脉（经其他方法证实）的患者被排除在外。血管超声检查是一种客观评估。它能很好地评估动静脉内瘘建立所需的动脉和静脉情况。该技术的局限性在于无法直接观察到中心静脉。尽管通过注射放射性造影剂对静脉进行成像能最佳地显示外周静脉和中心静脉，但这会使患者面临放射性造影剂诱发肾病的风险。本文介绍了这三种造影技术的优缺点，并提出了一种针对慢性肾病患者进行血管造影的策略。
