经皮双功超声检查测得的收缩期峰值流速及流速比值升高与动静脉内瘘中具有血流动力学意义的病变相关。

Elevated Peak Systolic Velocity and Velocity Ratio from Duplex Ultrasound are Associated with Hemodynamically Significant Lesions in Arteriovenous Access.

作者信息

Plato Steven A, Kudlaty Elizabeth A, Allemang Matthew T, Kendrick Daniel E, Wong Virginia L, Wang John C, Kashyap Vikram S

机构信息

Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University Hospitals Case Medical Center (UHCMC), Cleveland, OH.

Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH.

出版信息

Ann Vasc Surg. 2016 Aug;35:68-74. doi: 10.1016/j.avsg.2016.01.056. Epub 2016 Jun 3.

DOI:10.1016/j.avsg.2016.01.056

PMID:27263815

Abstract

BACKGROUND

Duplex ultrasound (DUS) is reliably used to detect lesions in the peripheral and carotid arterial beds and venous system. Although commonly used in clinical practice, duplex criteria to define lesions in arteriovenous access are not well characterized. This study will define the optimal Doppler-derived peak systolic velocity (PSV) and velocity ratio (VR) to identify >50% lesions in arteriovenous fistulas (AVF) and arteriovenous grafts (AVG).

METHODS

This retrospective analysis includes patients with both DUS and fistulogram within 30 days. DUS-derived PSV and VR were recorded for 3 segments of each access and compared with fistulograms of the same 3 segments of each AV access. Receiver operating characteristic (ROC) was used to determine the optimal DUS criteria for diagnosis of >50% stenosis.

RESULTS

Fifty pairs of imaging in 40 patients were available for analysis. Mean PSV and VR for segments with greater than 50% stenosis were significantly greater than those without; mean PSV of 480 cm/sec vs. 297 cm/sec (P < 0.001) and mean VR of 3.81 vs. 2.09 (P < 0.001). The ROC analysis demonstrated an optimal PSV of 404 and VR of 2.2 to diagnose >50% stenosis with area under the curve of 0.825 and 0.821 for PSV and VR, respectively. PSV of 500 had sensitivity (Se) of 0.60, specificity (Sp) of 0.86, positive predictive value (PPV) of 0.72, and negative predictive value (NPV) of 0.78. VR of 3.0 had Se of 0.52, Sp of 0.91, PPV of 0.77, and NPV of 0.75.

CONCLUSIONS

DUS-derived PSV of 400 cm/sec and VR of 2.25 have good discrimination to predict greater than 50% stenosis in AVFs and AVGs. Given the broad range of velocities in AV accesses, a threshold of PSV greater than 500 cm/sec and VR greater than 3.0, will reliably identify graft-threatening lesions. Se and Sp of PSV 500 are 0.596 and 0.854, respectively. Se and Sp for VR 3.0 are 0.519 and 0.894, respectively.

摘要

背景

双功超声（DUS）可可靠地用于检测外周和颈动脉床以及静脉系统中的病变。尽管在临床实践中常用，但用于定义动静脉通路病变的双功超声标准尚未得到充分描述。本研究将确定最佳的多普勒衍生收缩期峰值流速（PSV）和流速比（VR），以识别动静脉内瘘（AVF）和动静脉移植物（AVG）中>50%的病变。

方法

这项回顾性分析纳入了在30天内同时接受DUS和瘘管造影的患者。记录每个通路3个节段的DUS衍生PSV和VR，并与每个AV通路相同3个节段的瘘管造影结果进行比较。采用受试者操作特征（ROC）曲线来确定诊断>50%狭窄的最佳DUS标准。

结果

40例患者的50对影像可供分析。狭窄程度>50%的节段的平均PSV和VR显著高于无狭窄的节段；狭窄程度>50%节段的平均PSV为480 cm/秒，而无狭窄节段为297 cm/秒（P < 0.001），平均VR分别为3.81和2.09（P < 0.001）。ROC分析显示，诊断>50%狭窄的最佳PSV为404，VR为2.2，PSV和VR的曲线下面积分别为0.825和0.821。PSV为500时，灵敏度（Se）为0.60，特异度（Sp）为0.86，阳性预测值（PPV）为0.72，阴性预测值（NPV）为0.78。VR为3.0时，Se为0.52，Sp为0.91，PPV为0.77，NPV为0.75。

结论

DUS衍生的PSV为400 cm/秒和VR为2.25对预测AVF和AVG中>50%的狭窄具有良好的鉴别能力。鉴于AV通路中的流速范围广泛，PSV大于500 cm/秒和VR大于3.0的阈值将可靠地识别威胁移植物的病变。PSV为500时的Se和Sp分别为0.596和0.854。VR为3.0时的Se和Sp分别为0.519和0.894。