山本 裕也, 大川 博永, 藤田 淳也, 西川 博幸

Yuya YAMAMOTO, Hirohisa OKAWA, Jyunya FUJITA, Hiroyuki NISHIKAWA

大川VA透析クリニック

Okawa Vascular Access Dialysis Clinic

キーワード : vascular access, arteriovenous fistula, arteriovenous graft, ultrasonography, preoperative evaluation

バスキュラーアクセス（VA）は血液透析患者にとって不可欠なものである．特に透析導入時に作製する最初のVAは最も重要なものである．よって，VA作製前の評価は十分に行う必要があり，超音波検査は有効な評価方法である．術前評価では，超音波検査の前に視診・触診により観察する．超音波検査による評価：動脈は狭窄や閉塞の有無と血管内径を計測し，その開存性を評価する．また石灰化の程度を観察する．動静脈径は1.5～2.0 mm以上であれば作製可能と報告されている．静脈は全体の血管走行とその連続性，血管内径，狭窄の有無や静脈弁の位置などを観察する．吻合する静脈径は，駆血下にて2.0 mm以上が望ましい．また，触診のときと同様で穿刺可能な部位を検索する．血管走行は深さ5 mm以上になると触知が難しくなり，穿刺の難易度が上がるため，穿刺が想定される部位の血管の深さも観察する．結論：最終的な作製部位は，年齢，穿刺部位，動静脈の距離など血管径以外の要素も考慮し総合的に判断される．よって，作製部位の決定は超音波検査の結果と患者背景を術者と十分に協議する必要がある．可能であれば検査者と術者が一緒に評価を行うことが望ましい．

Vascular access (VA) is essential for hemodialysis patients. The first VA produced at dialysis introduction, in particular, is the most important. Therefore, sufficient evaluation before VA production is necessary, and ultrasonic inspection is an effective method for that purpose. In the preoperative evaluation, observation by inspection and palpation is performed before ultrasonic examination. Evaluation by ultrasonic examination: The artery is measured for the presence or absence of stenosis and occlusion, and the inner diameter of the blood vessel and its patency are evaluated. The degree of calcification should also be observed. It is reported that VA is feasible if the arteriovenous diameter is 1.5 to 2.0 mm or more. For the vein, the entire vessel course and its continuity, vessel inner diameter, presence or absence of stenosis, position of a venous valve, and the like are observed. The anastomotic vein diameter is preferably 2.0 mm or more under avascularization. In addition, as with palpation, a search is made for a puncturable site. If the depth of the vessel is 5 mm or more, it becomes difficult to palpate and the difficulty level of the puncture increases, so we also observe the depth of the blood vessel at the expected puncture site. Conclusion: The final production site is judged comprehensively, taking into account factors other than vessel diameter such as age, puncture site, arteriovenous distance, and so on. Therefore, it is necessary to sufficiently discuss the results of the ultrasonic examination and the patient background with the operator for determination of the production site. If possible, it is desirable for the examiner and the operator to work together.