南 雅人¹, 辻本 麻愉¹, 西本 綾子², 坂口 美佳³, 大野 恭裕^{1, 4}, 竹中 清悟⁵

Masahito MINAMI¹, Mayu TUJIMOTO¹, Ayako NISHIMOTO², Mika SAKAGUCHI³, Yasuhiro OONO^{1, 4}, Kiyonori TAKENAKA⁵

¹近畿大学医学部附属病院中央臨床検査部, ²近畿大学医学部附属病院臨床工学部, ³近畿大学医学部附属病院腎臓内科, ⁴近畿大学医学部附属病院内分泌・代謝・糖尿病内科, ⁵近畿大学医学部奈良病院臨床検査部

¹Department of Clinical Laboratory, Kindai University Hospital, ²Department of Clinical Engineering, Kindai University Hospital, ³Department of Nephrology, Kindai University Hospital, ⁴Department of Endocrinology and Metabolism·Diabetes Medicine, Kindai University Hospital, ⁵Department of Clinical Laboratory, Kindai University Nara Hospital

キーワード : vascular access, arteriovenous fistula, resistance index, brachial artery, radial artery

2014年1月から2017年4月の期間において，バスキュラーアクセス超音波検査（VA超音波検査）における上腕動脈の抵抗指数（resistance index: RI）0.60以上であった38症例を対象に，橈骨動脈RIから，責任病変部位の推測が可能かを検討した．橈骨動脈のRIが0.60以上であった11症例中10症例で，自己血管内シャント吻合部近位に内腔が1.5 mm以下の狭窄または閉塞を認めた．橈骨動脈のRIが0.60未満であった27症例中14症例では，吻合部遠位に内腔径が1.5 mm以下の狭窄または閉塞を認め，また，9症例では内腔径1.5 mm以下の狭窄は認めなかった．今回の検討から，VA超音波検査で上腕動脈RIと共に橈骨動脈RIの確認を行う事で，責任病変部位を推測して検査が可能と考えられたので報告する．

The possibility of estimating the culprit lesion on the basis of the radial artery resistance index (RI) was investigated in 38 subjects who underwent ultrasound-guided vascular access during the period from January 2014 to April 2017, and who had a brachial artery RI of >=0.60. Ten out of 11 patients with radial artery RI of >=0.60 exhibited occlusion due to stricture with a lumen of less than 1.5 mm near the arteriovenous fistula (AVF) anastomosis. Fourteen out of 27 patients with a radial artery RI of <0.60 exhibited occlusion due to stricture with a lumen of <=1.5 mm away from the anastomosis site, and in nine cases there was no stricture with a lumen of <=1.5 mm. Based on the present study, we believe that it is possible to estimate and examine abnormal findings (location) by verifying RI in both the brachial and radial arteries by ultrasound-guided vascular access.