Dimopoulou Angeliki, Raland Hans, Wikström Björn, Magnusson Anders
Department of Radiology, University Hospital, Uppsala, Sweden.
Acta Radiol. 2011 Nov 1;52(9):935-42. doi: 10.1258/ar.2011.110255. Epub 2011 Oct 3.
Arteriovenous fistulas and grafts are the methods of choice for vascular access in renal failure patients in need of hemodialysis. Their major complication, however, is stenosis, which might lead to thrombosis.
To demonstrate the usefulness of 16-MDCTA with 3D image reconstructions, in long-term hemodialysis patients with dysfunctional arteriovenous fistulas and grafts (AVF and AVG).
During a 17-month period, 31 patients with dysfunctional AVF and AVG (24 AVF and seven AVG) were examined with MDCTA with 3D image postprocessing. Parameters such as comprehension of the anatomy, quality of contrast enhancement, and pathological vascular changes were measured. DSA was then performed in 24 patients.
MDCTA illustrated the anatomy of the AVF/AVG and the entire vascular tree to the heart, in a detailed and comprehensive manner in 93.5% of the evaluated segments, and depicted pathology of AVF/AVG or pathology of the associated vasculature. MDCTA demonstrated a total of 38 significant stenoses in 25 patients. DSA verified 37 stenoses in 24 patients and demonstrated two additional stenoses. MDCTA had thus a sensitivity of 95%. All 24 patients were treated with percutaneous transluminal angioplasty (PTA) with good technical results.
MDCTA with 3D reconstructions of dysfunctioning AVFs and AVGs in hemodialysis patients is an accurate and reliable diagnostic method helping customize future intervention.
动静脉内瘘和移植物是需要血液透析的肾衰竭患者血管通路的首选方法。然而，其主要并发症是狭窄，这可能导致血栓形成。
证明16层螺旋CT血管造影（MDCTA）结合三维图像重建在长期血液透析且动静脉内瘘和移植物（AVF和AVG）功能障碍患者中的实用性。
在17个月期间，对31例AVF和AVG功能障碍患者（24例AVF和7例AVG）进行了MDCTA检查及三维图像后处理。测量了解剖结构清晰度、对比增强质量和病理性血管变化等参数。然后对24例患者进行了数字减影血管造影（DSA）。
MDCTA在93.5%的评估节段中详细、全面地显示了AVF/AVG的解剖结构以及通向心脏的整个血管树，并描绘了AVF/AVG的病变或相关脉管系统的病变。MDCTA共显示25例患者有38处明显狭窄。DSA证实24例患者有37处狭窄，并发现另外2处狭窄。因此，MDCTA的敏感性为95%。所有24例患者均接受了经皮腔内血管成形术（PTA），技术效果良好。
MDCTA结合三维重建用于血液透析患者功能不良的AVF和AVG检查是一种准确可靠的诊断方法，有助于定制未来的干预措施。
