Robbin M L, Oser R F, Allon M, Clements M W, Dockery J, Weber T M, Hamrick-Waller K M, Smith J K, Jones B C, Morgan D E, Saddekni S
Dept of Radiology, University of Alabama, Birmingham 35233, USA.
Radiology. 1998 Sep;208(3):655-61. doi: 10.1148/radiology.208.3.9722842.
To prospectively evaluate the sensitivity of ultrasonography (US) in diagnosing stenosis of hemodialysis access grafts and their drainage veins in patients clinically suspected of having graft dysfunction.
Thirty-eight patients in whom dysfunction of their hemodialysis access grafts was suspected underwent both Doppler US and angiography. Gray-scale and color US were combined with spectral analysis of the graft, anastomoses, and venous outflow. Flow velocity at anastomoses and suspected stenotic areas was measured. The volume of flow in the graft was also measured. The prospective US criterion for diagnosis of stenosis was a focal twofold or higher elevation of peak systolic velocity (PSV) compared with the PSV immediately upstream. A blinded angiographic evaluation of the graft and drainage veins followed US. Angiographic diagnosis of stenosis required at least 50% narrowing in luminal diameter. US and angiographic results were then compared.
Angiography allowed diagnosis of 43 stenoses in 34 patients. US depicted 92% (37 of 40) of these stenoses, with a 94% positive predictive value for any individual patient. Focal 2- to 2.9-times PSV elevation was associated with 75% or greater stenosis. Graft flow volume and resistive index change did not correlate with stenosis.
US reliably depicts stenoses of hemodialysis access grafts and drainage veins in a clinically selected population when PSV criteria are used.
前瞻性评估超声检查（US）对临床怀疑存在移植血管功能障碍患者的血液透析通路移植物及其引流静脉狭窄的诊断敏感性。
38例怀疑血液透析通路移植物功能障碍的患者接受了多普勒超声和血管造影检查。灰阶超声和彩色超声与移植物、吻合口及静脉流出道的频谱分析相结合。测量吻合口和疑似狭窄区域的流速。还测量了移植物中的血流量。诊断狭窄的前瞻性超声标准是与紧邻上游的收缩期峰值流速（PSV）相比，局部PSV升高两倍或更高。在超声检查后对移植物和引流静脉进行盲法血管造影评估。血管造影诊断狭窄要求管腔直径至少狭窄50%。然后比较超声和血管造影结果。
血管造影诊断出34例患者中的43处狭窄。超声显示了其中92%（40处中的37处）的狭窄，对任何个体患者的阳性预测值为94%。PSV局部升高2至2.9倍与75%或更高的狭窄相关。移植物血流量和阻力指数变化与狭窄无关。
当使用PSV标准时，超声能够可靠地显示临床选定人群中血液透析通路移植物和引流静脉的狭窄情况。
