Ćosović Admira, van der Kleij Frank Gh, Callenbach Petra Mc, Hoekstra Marion C, Hissink Rutger J, van den Berg Michiel
Department of Surgery, Treant Care Group, Emmen, The Netherlands.
Department of Internal Medicine, Treant Care Group, Emmen, The Netherlands.
J Vasc Access. 2020 Mar;21(2):217-222. doi: 10.1177/1129729819869998. Epub 2019 Aug 28.
To determine the value of duplex ultrasound in the detection of significant (⩾50%) stenosis and the location of the stenosis in arteriovenous fistula, compared to angiography.
Patients who underwent construction of an autologous arteriovenous fistula between January 2007 and December 2013 in Treant Care Group, hospital location Emmen, were included in this study. In all patients with a significantly decreased blood flow (flow <400 mL/min and/or ⩾20% decrease) measured by Transonic flowmeter before December 2016, duplex ultrasound was performed. Concordance between duplex ultrasound and angiography was analysed in all patients with a haemodynamically significant stenosis detected by duplex ultrasound.
In all, 63 patients had a significant decrease in blood flow leading to duplex ultrasound. In 51 (80.9%) of the 63 duplex ultrasound, a haemodynamically significant stenosis was detected. In 45 (88.2%) of these, angiography was performed, all confirming the presence of significant stenosis. In eight patients, no angiography was performed (sufficient residual blood flow (n = 7), death (n = 1)). Most stenoses were located in the venous outflow tract (75.6%). In 95.6%, a venous approach was possible during angiography. After intervention, a significant increase in blood flow was observed (from 530 mL/min to 910 mL/min (p < 0.001)).
We show that duplex ultrasound is likely reliable to ascertain the presence of arteriovenous fistula stenosis in addition to flow criteria. Also, it provides important information to select the most effective and safe approach for cannulation. Duplex ultrasound may reduce costs and burden of diagnosing stenoses.
与血管造影术相比，确定双功超声在检测动静脉内瘘中显著（≥50%）狭窄及狭窄部位的价值。
纳入2007年1月至2013年12月在位于埃门的特兰特护理集团接受自体动静脉内瘘构建的患者。在2016年12月之前，对所有经Transonic流量计测量血流显著减少（血流<400 mL/min和/或减少≥20%）的患者进行双功超声检查。对所有经双功超声检测出有血流动力学显著狭窄的患者，分析双功超声与血管造影术之间的一致性。
共有63例患者血流显著减少，从而接受了双功超声检查。在这例63次双功超声检查中，有51例（80.9%）检测到血流动力学显著狭窄。其中45例（88.2%）进行了血管造影术，均证实存在显著狭窄。8例患者未进行血管造影术（残余血流充足（n = 7），死亡（n = 1））。大多数狭窄位于静脉流出道（75.6%）。95.6%的患者在血管造影术期间可采用静脉入路。干预后，观察到血流显著增加（从530 mL/min增至910 mL/min（p < 0.001））。
我们表明，除血流标准外，双功超声可能可靠地确定动静脉内瘘狭窄的存在。此外，它还为选择最有效和安全的插管方法提供重要信息。双功超声可降低诊断狭窄的成本和负担。
