【摘要】 目的 探讨外周血管动静脉瘘的超声特征及其鉴别诊断。 方法 回顾性分析2003年1月-2010年3月间收治的36例先天性及后天性动静脉瘘患者的临床资料，使用彩色超声诊断仪观察受累血管的内径、血管壁的连续性，根据血流动力学变化寻找瘘口；对受累血管血流频谱进行分析，并与健侧对照。 结果 18例先天性动静脉瘘查见纡曲扩张的血管网，无法辨认瘘口；18例后天性动静脉瘘全部可显示瘘口，2例合并静脉破裂的为囊瘤型，其余后天性动静脉瘘均为洞口型。受累动脉近心端血流为高速低阻型，全部患者受累静脉出现动脉样血流，近心端静脉呈高速低阻型频谱；10例患者远心端静脉内出现逆向离心血流。 结论 引流静脉出现高速、动脉样血流频谱是动静脉瘘的特征性表现；先天性动静脉瘘可见异常血管网，不能辨认瘘口；后天性动静脉瘘均可显示瘘口。彩色超声多普勒检查对动静脉瘘能够正确诊断及鉴别诊断。【Abstract】 Objective To observe characteristic imaging of arteriovenous fistulas (AVF) of periphery vessel, and to evaluate the differential diagnosis of AVF by ultrasonography. Methods Thirty-six patients suffering from congenital and acquired AVF in this hospital from January 2003 to March 2010 were selected to undergo Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow characters of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Deformed vascular net was observed, and the localization of arteriovenous fistulas was not observed directly in 18 congenital AVF patients.Inversely the localization of arteriovenous fistulas was observed directly in 18 acquired AVF patients.Two acquired AVF patients with venous rupture belonged to kystoma form, and others acquired AVF patients belonged to orifice form.Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance.Arterialized flow pattern was observed in affected veins.Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance.Reversed blood flow was observed in the distal veins of the fistulas in 10 patients. Conclusion Arterialized flow with high velocity in veins are characteristic signs of AVF.Deformed vascular net is observed, and the localization of arteriovenous fistulas in not observed directly in congenital AVF patients, but the localization of arteriovenous fistulas is observed directly in acquired AVF patients.Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of AVF.
The way of intravenous drug abuse is to puncture the peripheral blood vessels and inject the drug directly into the blood. Therefore, this method has an impact on the peripheral artery and venous system of the users, and can cause a variety of peripheral vascular diseases, such as phlebitis, deep vein thrombosis, chronic venous insufficiency, phlebangioma, atherosclerosis, acute arterial ischemia, pseudoaneurysm, etc. However, due to the particularity of drug abusers, the vascular complications caused by intravenous drug abuse have not attracted enough attention. This paper reviewed the types and pathogenesis of peripheral vascular diseases caused by intravenous drug abuse, so as to improve the clinical understanding of peripheral vascular diseases caused by intravenous drug abuse, improve the prognosis of patients, reduce occupational exposure of medical staff, and play a certain role in social warning.
Trans-radial access (TRA) has been a common approach to percutaneous coronary intervention (PCI). Comparing with trans-femoral access (TFA), TRA is used as an alternative approach for PCI with less local complications, higher comfort level, and better outcome. In recent years, TRA has been paid more and more attention in peripheral vascular interventions. We reviewed recent developments in peripheral vascular intervention using TRA, with detail summary of the effectiveness, safety, limits, and future developments of it, aiming to improve the understanding and performance of TRA in interventionalists to benefit patients.
Peripheral vascular path is an important approach for minimally invasive cardiovascular surgery and cardiovascular interventional diagnosis and treatment, and the treatment of the vascular approach after surgery is directly related to the postoperative braking time and comfort of patients. The traditional treatment methods mainly include compression fixation of puncture point or incision of skin to suture blood vessels, but the disadvantages such as long postoperative immobilization, potential vascular complications and patient discomfort are obvious. The application of vascular closure devices can reduce the shortcomings of traditional treatment methods, but different vascular closure devices have their characteristics and application scope, and improper application may lead to serious complications. This paper reviewed the information of several commonly used vascular closure device and relevant clinical research data in recent years, and introduced the characteristics, application and clinical effects of common vascular closure devices.