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| Clinical significance of CT angiography in detecting hemodynamic parameters after autologous arteriovenous fistulaplasty in hemodialysis patients |
| JIA Xiufen1 LIU Jinjin1 ZHENG Chenfei2 |
1.Department of Radiology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou 325000, China;
2.Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang Province, Wenzhou 325000, China |
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Abstract Objective To observe the hemodynamic parameters in the numerical model established under the CT angiography (CTA) detection data after autologous arteriovenous fistulaplasty (AVF) in hemodialysis patients. Methods From April 2019 to April 2020, 80 hemodialysis patients in the First Affiliated Hospital of Wenzhou Medical University were retrospectively analyzed. According to the patient’s hemodialysis results, they were divided into the dysfunction group (21 cases) and the control group (59 cases), and the hemodynamic parameters of two groups were compared and the predictive value of hemodynamic parameters for AVF dysfunction were analyzed. Results The blood flow velocity at the venous end of the anastomosis after AVF in the dysfunction group was lower than that of the control group, and the radial artery shear force was higher than that of the control group, and the differences were statistically significant (P < 0.05). Logistic regression analysis showed that slow blood flow velocity at the venous end of the anastomosis, high radial artery shear force were the influencing factors of AVF dysfunction (OR > 1, P < 0.05). Area under curve of blood flow velocity at the venous end of the anastomosis and radial artery shear force for AVF dysfunction prediction were 0.847 and 0.843 respectively, and the combined detection was 0.943. Conclusion The high incidence of AVF dysfunction after autologous AVF in hemodialysis patients may be related to slow blood flow velocity at the venous end of the anastomosis and high radial artery shear force. The blood flow velocity and radial artery shear force embodied in the numerical model established under the early CTA detection data can predict the risk of dysfunction after AVF and may have positive significance on guiding AVF effect evaluation and early intervention in hemodialysis patients.
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[1] 谢凌，程瑞红，朱丽萍.彩色多普勒超声评估血透患者动静脉内瘘并发症的应用价值[J].中国数字医学，2019，14（9）：53-55，52.
[2] 蔡寸，伦龙威，李茵，等.通络活血沐手方治疗血液透析患者动静脉内瘘成熟不良的临床效果[J].中国医药导报，2019，16（18）：129-132.
[3] Ren C，Chen J，Wang Y，et al. Application of ultrasonography in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients [J]. Medicine（Baltimore），2018，97（44）：e12994.
[4] 冯薇，朱好辉.彩超在评估自体动静脉内瘘狭窄、血栓生成情况中的应用价值分析[J].诊断学理论与实践，2019， 18（3）：360-364.
[5] 孟临侠，何芳，王凤，等.彩超评估血液透析患者动静脉内瘘血栓及狭窄的临床价值[J].海南医学，2017，28（12）：1981-1983.
[6] 刘玉倩，伍珩，李萌，等.冠状动脉分叉病变单支架植入术后血流动力学分析[J].北京生物医学工程，2019，38（6）：583-589.
[7] Lok CE，Rajan DK，Clement J，et al. Endovascular Proximal Forearm Arteriovenous Fistula for Hemodialysis Access：Results of the Prospective，Multicenter Novel Endovascular Access Trial（NEAT）[J]. Am J Kidney Dis，2017，70（4）：486-497.
[8] 中国医师协会肾脏病医师分会血液透析充分性协作组.中国血液透析充分性临床实践指南[J].中华医学杂志，2015，95（34）：2748-2753.
[9] 陶杰，张凡，吴晓波，等.超声测量肱动脉血流量与标准内瘘术后透析流量的相关性研究[J].中华超声影像学杂志，2015，24（7）：576-579，583.
[10] 谢筱彤，刘宏，涂岩，等.维持性血液透析患者动静脉内瘘功能不良的影响因素[J].肾脏病与透析肾移植杂志，2018，27（5）：435-439.
[11] Gonzalez AJ，Casey KM，Drinkwine BJ，et al. Series of Noncontrast Time-of-Flight Magnetic Resonance Angiographies to Identify Problems with Arteriovenous Fistula Maturation [J]. Ann Vasc Surg，2016，30：93-99.
[12] 沈正林，谷涌泉，张娟.前臂自体动静脉内瘘数字减影静脉造影方法分析[J].介入放射学杂志，2020，29（3）：237-240.
[13] 陈东燃，冯碧仪，饶鼎荣.缺血性血管病患者应用全脑数字减影血管造影联合神经介入术治疗效果[J].中外医学研究，2020，18（30）：56-57.
[14] Merritt CR. Doppler color flow imaging [J]. J Clin Ultrasound，1987，15（9）：591-597.
[15] 黄永，刘兴钊，黄蕊，等.超声诊断技术在终末期肾脏疾病动静脉造瘘中的临床应用价值[J].中国医药导报，2018，15（34）：140-143，148.
[16] Bouillot P，Brina O，Chnafa C，et al. Robust cerebrovascular blood velocity and flow rate estimation from 4D-CTA [J]. Med Phys，2019，46（5）：2126-2136.
[17] 孔艳红，钟朝辉，张景东，等.生理盐水双段注射方法在头颈CTA成像检查中的应用研究[J].临床和实验医学杂志，2019，18（18）：2012-2015.
[18] 赵忠江.3D-CTA引导下显微手术治疗颅内动脉瘤的疗效观察[J].中国医药导报，2012，9（21）：150-151.
[19] 张耀楠，张慧娥，尹慧平.基于Carreau模型的主动脉弓血流动力学特性分析[J].医疗卫生装备，2018，39（10）：1-5.
[20] 谢祖龙，房炎，王学懂，等.血流剪切力对支架内新生动脉粥样硬化形成的影响[J].现代生物医学进展，2018， 18（8）：1479-1483，1568.
[21] Hanke J，Ranke C，Perego E，et al. Human blood platelets contract in perpendicular direction to shear flow [J]. Soft Matter，2019，15（9）：2009-2019.
[22] Jiang Z，Yu P，Tao M，et al. Interplay of CCR2 signaling and local shear force determines vein graft neointimal hyperplasia in vivo [J]. FEBS Lett，2009，583（21）：3536-3540.
[23] 沈燕，陈冬梅，明志兵，等.尿毒症自体动静脉内瘘失功患者血浆sEPCR水平变化及意义[J].山东医药，2017， 57（36）：84-86.
[24] 王立华，姜埃利，魏芳.动静脉内瘘建立后的血流动力学变化[J].中华肾脏病杂志，2015，31（10）：797-800.
[25] 宁海欢，卓华钦，荣光，等.内皮细胞标记物及间充质细胞/肌成纤维细胞标记物在动静脉内瘘狭窄血管中的表达[J].海南医学，2018，29（7）：898-900.
[26] Cheung AK，Imrey PB，Alpers CE，et al. Intimal Hyperplasia，Stenosis，and Arteriovenous Fistula Maturation Failure in the Hemodialysis Fistula Maturation Study [J]. J Am Soc Nephrol，2017，28（10）：3005-3013.
[27] 杨雄，曾保尧，左江伟.接受自体动静脉内瘘术的兔动静脉吻合口静脉端颈外静脉内膜厚度及自噬相关蛋白表达观察[J].山东医药，2019，59（24）：44-47.
[28] 徐皖东，黄丽丹，张树超.血液透析患者自体动静脉内瘘狭窄处VEGF-A、趋化因子表达及与b-FGF的相关性[J].中国医师杂志，2020，22（5）：709-713. |
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