【摘要】 目的 探討外周血管動(dòng)靜脈瘺的超聲特征及其鑒別診斷。 方法 回顧性分析2003年1月-2010年3月間收治的36例先天性及后天性動(dòng)靜脈瘺患者的臨床資料，使用彩色超聲診斷儀觀察受累血管的內(nèi)徑、血管壁的連續(xù)性，根據(jù)血流動(dòng)力學(xué)變化尋找瘺口；對(duì)受累血管血流頻譜進(jìn)行分析，并與健側(cè)對(duì)照。 結(jié)果 18例先天性動(dòng)靜脈瘺查見(jiàn)紆曲擴(kuò)張的血管網(wǎng)，無(wú)法辨認(rèn)瘺口；18例后天性動(dòng)靜脈瘺全部可顯示瘺口，2例合并靜脈破裂的為囊瘤型，其余后天性動(dòng)靜脈瘺均為洞口型。受累動(dòng)脈近心端血流為高速低阻型，全部患者受累靜脈出現(xiàn)動(dòng)脈樣血流，近心端靜脈呈高速低阻型頻譜；10例患者遠(yuǎn)心端靜脈內(nèi)出現(xiàn)逆向離心血流。 結(jié)論 引流靜脈出現(xiàn)高速、動(dòng)脈樣血流頻譜是動(dòng)靜脈瘺的特征性表現(xiàn)；先天性動(dòng)靜脈瘺可見(jiàn)異常血管網(wǎng)，不能辨認(rèn)瘺口；后天性動(dòng)靜脈瘺均可顯示瘺口。彩色超聲多普勒檢查對(duì)動(dòng)靜脈瘺能夠正確診斷及鑒別診斷。【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.
靜脈吸毒的吸食方式為穿刺外周血管，將毒品直接注入到血液中，因此這一方式對(duì)吸食者的外周動(dòng)脈、靜脈系統(tǒng)皆有影響，可造成多種外周血管疾病，如靜脈炎、深靜脈血栓形成、慢性靜脈功能不全、靜脈瘤、動(dòng)脈粥樣硬化、急性動(dòng)脈缺血、假性動(dòng)脈瘤等。但因?yàn)槲菊哌@一人群的特殊性，靜脈吸毒引起的血管并發(fā)癥并未引起足夠的重視。該文對(duì)由靜脈吸毒引起的外周血管疾病種類(lèi)及發(fā)病機(jī)制進(jìn)行綜述，以期提高臨床對(duì)由靜脈吸毒引發(fā)的外周血管疾病的認(rèn)識(shí)，有利于改善患者預(yù)后，減少醫(yī)護(hù)人員職業(yè)暴露，還能夠起到一定的社會(huì)警示作用。
橈動(dòng)脈入路已是冠狀動(dòng)脈介入診療的常規(guī)路徑，與股動(dòng)脈入路相比具有局部并發(fā)癥少、患者舒適度高、改善患者預(yù)后等優(yōu)點(diǎn)，已獲得廣泛認(rèn)可與推薦。近年來(lái)，橈動(dòng)脈入路的外周血管介入也越來(lái)越受到重視。本文回顧了經(jīng)橈動(dòng)脈入路外周血管介入診療的發(fā)展歷程，結(jié)合最新研究進(jìn)展分析比較經(jīng)橈動(dòng)脈入路外周血管介入的優(yōu)勢(shì)、不足、注意事項(xiàng)以及未來(lái)發(fā)展問(wèn)題，以期使更多介入醫(yī)生能了解和應(yīng)用經(jīng)橈動(dòng)脈入路，進(jìn)而使患者在介入診療過(guò)程中有更多獲益。
外周血管徑路是微創(chuàng)心血管外科及心血管介入診療的重要途徑，手術(shù)后入路血管的處理方式直接關(guān)系到患者的術(shù)后制動(dòng)時(shí)間及舒適度。傳統(tǒng)的處理方法主要包括穿刺點(diǎn)壓迫固定或切開(kāi)皮膚縫合血管，術(shù)后長(zhǎng)時(shí)間制動(dòng)、血管潛在并發(fā)癥及患者舒適性差等缺點(diǎn)顯而易見(jiàn)。血管閉合器的應(yīng)用可以減少傳統(tǒng)處理方法的缺點(diǎn)，但是不同血管閉合器有其自身特點(diǎn)和應(yīng)用范圍，甚至應(yīng)用不當(dāng)可能會(huì)導(dǎo)致嚴(yán)重并發(fā)癥的發(fā)生。本文綜述了當(dāng)前常用的幾款血管閉合器資料以及近年來(lái)相關(guān)的臨床研究數(shù)據(jù)，對(duì)常用血管閉合器的特點(diǎn)、使用方法及臨床應(yīng)用效果作一介紹。