Lege Artis Medicinae

[Color doppler sonographic study of subcutan arteriovenosus (Cimino) shunts]


AUGUST 28, 1991

Lege Artis Medicinae - 1991;1(14)

[The color Doppler method is very useful for examining the arteriovenosus fistules, the patency of anastomoses, the diagnosis and follow-up of the stenoses and for the evaluation of the lesions developed around the anastomoses. Using an Acuson 128 color Doppler ultrasound equipment, the authors have examined the subcutan arterio venosus shunts of 50 patients treated with chronic haemodialysis. 46 patients had Cimino fistulas on the lower arm, 2 had on the forearm, while two patients had graft on the forearm. In each cases the artery, the anastomosis, the vein of the shunt and the site of the punction were examined. The authors have found normal, well functioning anastomoses in 11 cases, while 29 dilatations, 8 stenoses, 2 occlusions, 1 infection, 5 haematomas and in one case dilated collateral vessels were diagnosed. The authors consider the color Doppler sonographic technique reliable for examining the function of the anastomosis, the morphologic changes, stenoses, dilatations, and the lesions developed around the shunts. The color Doppler examination is a non-invasive alternative diagnostic method opposed to angiography, which is more troblesome for these patients. ]


  1. Szent-Györgyi Albert Orvostudományi Egyetem Radiológiai Klinika



Further articles in this publication

Lege Artis Medicinae

[Laparoscopic surgery]

ANTAL András, BÁTFAI László, EZER Péter

[In the recent years abdominal surgery has developed quickly. Laparoscopic operating procedures have spread worldwide. These techniques have reached Hungary as well, though there are only few articles in this topic. Since last December - date of the first laparoscopic cholecystectomy – more than 200 operations have been done, among them the first appendectomy. These procedures are less troublesome for the patients with better cosmetic results, and the shorter period of hospitalisation and unability for work make economical advantages. First, the technical instruments and their usage, then personal coditions and the preparation programme are described. In the second part the usage of the new technique is summarized in cholecystectomy as well as in appendectomy. ]

Lege Artis Medicinae

[Report of the American Society of Gastrointestinal Endoscopic Surgeons Postgraduate Course and Scientific Meeting]


[This year's congress of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) was held in Monterey, California. As a fellow of the Department of Gastroenterology at the University of Southern California, I was able to attend the congress with the support of Dr. Berci, Professor of Surgery at Cedars-Sinai Hospital.]

Lege Artis Medicinae

[Quo vadis chirurgia biliaris?]

SÁNDOR József, IHÁSZ Mihály

[Mankind has suffered from the agony of gallstones for thousands of years. Until the second half of the last century, there was practically no cure, the only relief being spontaneous internal and external fistulas in the midst of great pain.]

Lege Artis Medicinae

[Renal cell carcinoma in a horseshoe kidney treated with radical nephrectomy]


[A horseshoe kidney is diagnosed usually after the onset of its complication or the symptoms caused by an arising tumor from it. A tumour was diagnosed in the right half of the horseshoe kidney in a 68 year old female patient by excretory urography, ultrasound examination and renovasography. The tumour was removed by radical nephrectomy. The kidney was exposed through a horizontal abdominal approach. Special attention was given to the separate renal arteries supplying the right half of the horseshoe kidney and to the resection of the isthmus and also regional lymphadenectomy. In the diagnosis of a horseshoe kidney excretion urography had exclusively been used earlier but nowadays ultrasound is playing an increasingly important role. Reno vasography is usually needed only before resection or nephrectomy. The appropriate treatment of a horseshoe kidney tumour - in case of a well functioning contralateral kidney - is radical ablastic tumour nephrectomy including regional lymphadenectomy. ]

Lege Artis Medicinae

[Recommended principles and strategies for pre-surgical evaluation and surgical resolution of epilepsy]


[I. General principles before surgical treatment of epilepsy; II. The surgical investigation process; III. Indications for surgery]

All articles in the issue

Related contents

Hungarian Radiology

[Initial experiences with upper limb MR-angiography]


[INTRODUCTION - Cimino fistula is created for chronic hemodialysis. As a common complication steal syndrome may occur. Till recently, color Doppler and catheter angiography were the gold-standard diagnostic tools. We have performed MR-angiography of the upper limb to replace the more invasive conventional angiography in patients with poor general condition. PATIENT AND METHODS - A case of a 64 years old female patient with known type II diabetes is presented. Due to azotemia, the patient has received hemodialysis for 24 months, via a left upper limb fistula. This fistula occluded, and the Cimino-fistula was later created on the right arm. This new fistula demonstrated steal syndrome, and required formal ligation. In the meantime a necrotising drygangrene of the 4th and 5th digits was recognised. This required an emergent conventional angiography, but due to the unavailability of accessible artery, MR-angiography was performed. 1.0 mmol/ml concentration gadobutrol (Gadovist 1.0, BayerSchering, Berlin) was used to reduce the chances of nephrogenic systemic fibrosis in this patient with poor renal function. CONCLUSION - Correctly performed MR-angiography to examine the possibility of steal syndrome in patients with a Cimino fistula can be a feasible alternative. The advantages of the procedure include its minimal invasiveness, no ionizing radiation and the risk of iodine-based contrast material nephrotoxicity. Also, as compared to digital substraction angiography, with MR-angiography we obtain a high-resolution, isotrope voxel-sized 3D acquisition which can be better read in many different planes. As a drawback, currently on-location intervention cannot be performed, if needed. Also, the waiting periods may be long.]

Lege Artis Medicinae

[Initial experiences with color doppler ultrasonography of rectal tumors]


[The authors report their one-year experiences with color-Doppler ultrasonography in the examination of rectal tumors. 160 transrectal ultrasound examinations were performed. The results of 30 cases with rectal cancer are reported. All 30 patients had gray-scale, pulsed Doppler and color Doppler endorectal ultrasound examination. The vascular structures of the tumors and the normal rectal wall were studied. Flow characteristics and pulsatility indices for arterial waveforms within the tumor tissue and within the normal wall were compared. Hypervascularisation was seen in all of the 30 tumors. In the tumor vessels an increased diastolic flow component was observed with lower pulsatility indices. The mean Pl was 1.206+0.394 (SD) (P<0.001). In the flow pattern of the normal submucosal arterial plexuses, the diastolic flow was absent or minimal and the mean PL was 3.168+1.151 (SD). Different color and pulsed Doppler signal types exist in rectal tumor tissue and in normal rectal wall. The investigation of rectal tumor vascularity may have a special importance in distinguishing tumor tissue from related perifocal oedema which is prerequisite to the determination of the extent of resection. ]

Lege Artis Medicinae

[A new ultrasound method for the examination of the circulation: color velocity imaging (CVI)]

HARKÁNYI Zoltán, DANIEL Morton, JI-BIN Liu, BARRY B. Goldberg

[The newest ultrasound method for the exa mination of the peripheral and abdominal vessels is Color Velocity Imaging (CVI) or time domain correlation method. In contrast to the widely accepted color Doppler imaging technique CVI is based on a different principle. Blood flow velocity is displayed using time-shift measurement ins tead of frequency-shift. This paper is brief summary of the principle of CVI method with a special emphasis on the new features. Improved special color resolution, direct velocity measurement from the color images and blood flow volume calculations are the most important new features. Authors preliminary clinical experience with this new ultrasound method is positive. A few illustrative cases demonstrate CVI and CVI-flowmetry in clinical practice. CVI is a promising new ultrasound method for imaging and quantification of human blood flow. ]