Improved evaluation of stenoses of hemodialysis fistulas by B-Flow ultrasound
Improved evaluation of stenoses of hemodialysis fistulas by B-Flow ultrasound
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DOI：
10.1055/s-2003-37889
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发表时间：
2003-03-01
影响因子：
1.8
通讯作者：
Rupp, N
中科院分区：
文献类型：
--
作者：
Jung, EM;Kubale, R;Rupp, N
目的：探讨B超血流显像评价内瘘狭窄的新技术。材料与方法：由独立检查者通过动脉内DSA和血管超声对50例（平均年龄58岁）Brescia-Cimino-Shunts（27例桡动脉和23例肘动脉分流）患者进行前瞻性评估。本研究的合格性是分流量小于400 ml/min，血管造影怀疑吻合口或分流静脉的血流动力学显著狭窄。超声检查采用多频超声探头（5 - 10 MHz，Logic 700，GE），采用B型、彩色编码多普勒超声（CCDS）和B流技术。结果：吻合口狭窄和分流静脉狭窄各25例。25例吻合口狭窄的残余管腔为1.47 ~ 3.43mm（平均：2.3 mm），动脉DSA，1.57 - 3.73 mm（平均：2.6 mm）B型超声，1.97至4.17 mm在亮度模式下，B流技术为1.43至3.47 mm（平均：2.3 mm），在B模式下，B流技术为1.6至3.47 mm（平均：2.4 mm）。B流的亮度模式与动脉DSA相关性最好（r = 0.994），CCDS与动脉DSA之间的相关性显著较低。B流显示狭窄内的血管扭曲较少，并且流动伪影较少。即使在成角狭窄中，与CCDS相比，检测到的狭窄内和狭窄后血流的角度依赖性明显更低。B型血流明显有助于低回声斑块和内膜增生的可视化。此外，与CCDS相比，DSA或B超未观察到的偏心性瘢痕狭窄、内膜瓣或低回声血栓显示出更好的可视化。结论：B超血流显像能较好地评价内瘘狭窄的形态及局部狭窄程度。实现了具有较少伪影和降低的角度依赖性的流动检测。这为更好地规划介入治疗开辟了道路。
Purpose: To evaluate the new technique of B-flow ultrasound in assessing stenoses of hemodialysis fistulas. Materials and Methods: 50 patients (mean age 58 years) with Brescia-Cimino-Shunts (27 shunts of the radial and 23 of the cubital artery) were prospectively assessed with intraarterial DSA and vascular ultrasound by independent examiners. Eligibility for the study was a shunt-volume of less than 400 ml/min and an angiographically suspected hemodynamically significant stenosis of the anastomosis or of shunt veins. Sonography was performed with a multifrequency ultrasound probe (5 to 10 MHz, Logic 700, GE) using B-mode, color coded Doppler sonography (CCDS) and B-flow technique. Results: Anastomotic stenosis and stenosis of the shunt veins were equally distributed, found in 25 patients each. The measurements of the residual lumen of the 25 anastomotic stenoses were 1.47 to 3.43 mm (average: 2.3 mm) for intraarterial DSA, 1.57 to 3.73 mm (average: 2.6 mm) for B-mode ultrasound, 1.97 to 4.17 mm (average: 2.9 mm) for CCDS, 1.43 to 3.47 mm (average: 2.3 mm) for B-flow technique in the brightness mode and 1.6 to 3.47 mm (average: 2.4 mm) for B-flow technique in the B-mode. The brightness mode of the B-flow correlated best with intraarterial DSA (r = 0.994), with a significantly lower correlation between CCDS and intraarterial DSA. B-flow displays less vascular distortion within the stenosis and fewer flow artifacts. Even in angulated stenoses, the detected intra- and poststenotic flow was markedly less angle-dependent in comparison with CCDS. B-flow clearly facilitates the visualization of hypoechoic plaques and intima proliferation. Furthermore, excentric cicatricial stenoses, intima flaps or hypoechoic thrombi, which were not seen with DSA or B-mode, showed improved visualization in comparison with CCDS. Conclusion: Ultrasound B-flow makes it easier to assess the morphology and the local degree of stenotic hemodialysis fistulas. Flow detection is achieved with fewer artifacts and reduced angle dependence. This opens the way for better planning of interventional therapy.