Gadallah M F, Paulson W D, Vickers B, Work J
Department of Medicine, University of Florida, Jacksonville 32209, USA.
Am J Kidney Dis. 1998 Aug;32(2):273-7. doi: 10.1053/ajkd.1998.v32.pm9708612.
A variety of techniques (physical examination, venous pump pressure, percent urea recirculation, Crit Line, Transonic Flow, and others) are helpful in detecting vascular access dysfunction with subsequent referral to fistulography for confirmation of stenosis and possible angioplasty. Although these techniques are adequate, it is not uncommon that the results in some patients may be borderline or equivocal. In these cases, Doppler ultrasound may play a role to confirm the presence or absence of significant stenosis before subjecting the patient to the more expensive and invasive fistulography. For Doppler ultrasound to play such a role, it must have a high degree of accuracy in diagnosing anatomic stenosis. In previous studies, percent stenosis by Doppler ultrasound as compared with percent stenosis by fistulography was examined only when stenosis was suspected, therefore not allowing the determination of Doppler ultrasound specificity in diagnosing negative stenosis when fistulography was negative. In this study, we evaluated 38 hemodialysis patients with Doppler ultrasound followed by fistulography, without regard to suspicion of stenosis (to access both the sensitivity and specificity of Doppler ultrasound). Nineteen patients (50%) had significant stenosis by fistulography (> or =50% narrowing). The same 19 patients had significant stenosis by Doppler ultrasound (significant stenosis at > or =40% with high-velocity flow turbulence or > or =50% without turbulent flow), whereas the remaining patients had no significant stenosis. In addition, the percent stenosis by Doppler ultrasound had a linear relationship to the percent stenosis by fistulography. In conclusion, Doppler ultrasound closely correlates to fistulography in diagnosing anatomic stenosis. In patients in whom other techniques for diagnosing access stenosis show borderline results, Doppler ultrasound may play an adjuvant role to confirm the presence or absence of significant stenosis.
多种技术（体格检查、静脉泵压、尿素再循环百分比、Crit Line、Transonic Flow等）有助于检测血管通路功能障碍，随后可转诊至血管造影以确认狭窄并可能进行血管成形术。尽管这些技术足够，但在一些患者中，结果处于临界状态或模棱两可的情况并不少见。在这些情况下，在让患者接受更昂贵且有创的血管造影之前，多普勒超声可能有助于确认是否存在明显狭窄。为了使多普勒超声发挥这样的作用，它在诊断解剖学狭窄方面必须具有高度准确性。在以往的研究中，仅在怀疑有狭窄时才比较多普勒超声测定的狭窄百分比与血管造影测定的狭窄百分比，因此无法确定在血管造影为阴性时多普勒超声诊断阴性狭窄的特异性。在本研究中，我们对38例血液透析患者先进行多普勒超声检查，然后进行血管造影，而不考虑是否怀疑有狭窄（以评估多普勒超声的敏感性和特异性）。19例患者（50%）血管造影显示有明显狭窄（狭窄≥50%）。这19例患者多普勒超声检查也显示有明显狭窄（高速血流紊乱时狭窄≥40%或无血流紊乱时狭窄≥50%），而其余患者无明显狭窄。此外，多普勒超声测定的狭窄百分比与血管造影测定的狭窄百分比呈线性关系。总之，在诊断解剖学狭窄方面，多普勒超声与血管造影密切相关。对于其他诊断通路狭窄的技术结果处于临界状态的患者，多普勒超声可能发挥辅助作用以确认是否存在明显狭窄。
