■功能良好的血管通路(VA)对于维持性血液透析(HD)的患者至关重要。中心静脉狭窄(CVS)是一种常见的,然而,被忽视的VA并发症,因为它的诊断是具有挑战性的。此外,之前没有很好地讨论其对流量(FV)和外围电阻指数(RI)的影响。尽管大多数中心都有多普勒超声(DUS),使用DUS直接可视化中央静脉是相当困难的。
■这是一项回顾性的单中心自我对照队列研究,该研究在日本专门的血管通路管理三级中心进行,纳入了所有CVS患者,这些患者在2014年1月至2022年9月期间接受了有或没有血管支架置入的经皮腔内血管造影(PTA)。根据患者的VA类型分为动静脉瘘(AVF),和动静脉移植(AVG)组,然后细分,根据狭窄的类型,分为两个子组:CVS,和混合中央和周围静脉狭窄(MVS)组。在PTA之前和之后的相同程序中比较了喂养动脉的FV和RI,以评估程序本身的影响。
■485例经皮腔内血管造影(PTA)的数据,收集了2014年1月至2022年9月期间的95例患者.MVS患者的FV和RI比CVS患者明显受影响。PTA之后,FV和RI均显著改善.MVS患者PTA后FV和RI的改良率明显高于CVS患者。然而,很难确定诊断或评估CVS改善的临界值.
■我们的研究结果表明,DUS测量FV和RI是很好的工具,以及在某些情况下评估CVS的临床发现。
UNASSIGNED: A well-functioning vascular access (VA) is crucial for the patients on maintenance hemodialysis (HD). Central venous stenosis (CVS) is a common, yet, overlooked complication of VA as its diagnosis is challenging. Moreover, its effect on the flow volume (FV) and the peripheral resistive index (
RI) was not well discussed before. Despite the availability of doppler ultrasound (DUS) in most centers, direct visualization of central veins using DUS is quite difficult.
UNASSIGNED: This is a retrospective single-center self-controlled cohort study that was conducted in a specialized vascular access management tertiary center in Japan and included all patients with CVS who underwent percutaneous transluminal angiography (PTA) with or without vascular stenting in the period from January 2014 to September 2022. The patients were divided according to their VA type into arteriovenous fistula (AVF), and arteriovenous graft (AVG) groups, then subdivided, according to the type of stenosis, into two subgroups: CVS, and mixed central and peripheral venous stenosis (MVS) groups. The FV and
RI of the feeding artery were compared in the same procedure before and after PTA to assess the impact of the procedure itself.
UNASSIGNED: Data of 485 percutaneous transluminal angiography procedures (PTA), performed in 95 patients during the period from January 2014 to September 2022, were collected. FV and
RI were significantly affected in the patients with MVS than patients with CVS. After PTA, both FV and
RI were significantly improved. The improvement rate of FV and
RI after PTA were significantly higher in patients with MVS than patients with CVS. However, it was difficult to determine the cut-off value to diagnose or to assess the improvement of CVS.
UNASSIGNED: Our findings suggest that FV and RI measurement by DUS are good tools, along with the clinical findings for assessment of CVS in certain situations.