Arteriovenous fistula creation with VasQ™ device: A feasibility study to reveal hemodynamic implications
Arteriovenous fistula creation with VasQ™ device: A feasibility study to reveal hemodynamic implications
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DOI：
10.1177/11297298221087160
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发表时间：
2022-04-22
影响因子：
1.9
通讯作者：
Remuzzi, Andrea
中科院分区：
文献类型：
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作者：
Bozzetto, Michela;Soliveri, Luca;Remuzzi, Andrea
背景：动静脉内瘘（AVF）是血液透析的首选血管通路（VA），但由于狭窄发展，它仍然受到高未成熟率和早期失败率的影响。越来越多的证据表明，类湍流的存在可能起着关键作用，因此，为了稳定静脉段的血流，设计了外部支撑装置（VasQTM）。本研究的目的是提供与传统手术创建的 AVF 相比 VasQ (TM) 对 AVF 血流动力学影响的初步证据。 方法：在这项试点单中心前瞻性随机研究中，纳入了 6 名患者，其中 3 名患者属于 VasQ 组，3 名患者属于对照组。在 AVF 手术后 3 天、3 个月和 1 年采集无对比磁共振成像 (MRI) 扫描，用于生成患者特异性的 3D 模型。使用 pimpleFoam 进行计算流体动力学 (CFD) 模拟，在近端和远端动脉入口处施加来自超声 (US) 检查的患者特定血流波形，并在静脉流出处施加无牵引条件。比较了 VasQ 和对照 AVF 之间随时间发生的形态和血流动力学变化。结果：我们的 MRI 协议提供了高质量的图像，适合对六名患者中的四名患者在所有三个时间点进行可靠的分割和重建患者特异性 AVF 3D 模型。随着时间的推移，VasQ (TM) 装置使动脉和静脉之间的角度几乎保持不变，该装置支持的 AVF 中的血流更加稳定。相比之下，对照组的一个 AVF 演变成静脉极度扩张和血流高度紊乱，而另一个 AVF 在近吻合区域出现狭窄。 结论：这项研究证明了表征使用 VasQ (TM) 装置创建的 AVF 随着时间的推移发生的形态和血流动力学变化的可行性，并提供了其使用的潜在血流动力学益处的初步证据。
Background: Arteriovenous fistula (AVF) is the preferred vascular access (VA) for hemodialysis, but it is still affected by high non-maturation and early failure rates due to stenosis development. Increasing evidence suggests that the presence of turbulent-like flow may play a key role, therefore, to stabilize the flow in the venous segment, an external support device (VasQTM) has been designed. The aim of this study was to provide preliminary evidence of VasQ (TM) impact on AVF hemodynamics as compared to AVFs created with conventional surgery.Methods: In this pilot single-center prospective randomized study six patients were enrolled, three in the VasQ group and three in the control group. Contrast-free magnetic resonance imaging (MRI) scans were acquired at 3 days, 3 months and 1 year after AVF surgery and were used to generate 3D patient-specific models. Computational fluid dynamic (CFD) simulations were performed using pimpleFoam, imposing patient-specific flow waveforms derived from ultrasound (US) examinations at the inlet of the proximal and distal artery, and a traction-free condition at the venous outflow. Morphologic and hemodynamic changes occurring over time were compared between VasQ and control AVFs.Results: Our MRI protocol provided high-quality images suitable for reliable segmentation and reconstruction of patient-specific 3D models of AVFs at all three timepoints in four out of six patients. The VasQ (TM) device maintained the angle between the artery and the vein almost unchanged over time, with a more stable flow in the AVFs supported by the device. In contrast, one of the AVFs of the control group evolved to an extreme dilatation of the vein and highly disturbed flow, while the other developed a stenosis in the juxta-anastomotic region.Conclusions: This study demonstrated the feasibility of characterizing the morphological and hemodynamic changes occurring over time in AVFs created using the VasQ (TM) device and provided preliminary evidence of the potential hemodynamic benefits of its use.