An Open-Source Ultrasound Software for Diagnosis of Fistula Maturation.
An Open-Source Ultrasound Software for Diagnosis of Fistula Maturation.
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DOI：
10.1097/mat.0000000000000590
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Shih AJ
中科院分区：
文献类型：
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作者：
Belmont B;Park DW;Weitzel WF;Shih AJ
血管通路对于血液透析患者至关重要。成熟的自体动静脉内瘘已成为血液透析的首选血管通路，因为它比合成移植物具有更长的寿命。然而，一旦手术创建，瘘管通常不能发展（成熟）为可行的血管通路点，在使用前需要手术或放射干预。由于成熟取决于血管力学（例如，扩张性和壁剪切），我们开发了开源超声软件来临床研究这些指标。我们在单个患者中证明了该软件在心动周期内和不同心动周期之间从不同位置进行一致测量的能力。我们进一步评估了该软件识别术后1 - 6周患者瘘管扩张性变化的能力。临床机器的常规帧率表现出在心动周期内（变异系数（CV）= 2.4% ± 0.011）和心动周期之间（CV = 2.4% ± 0.004）的高保真跟踪。术后1 ~ 6周，患者瘘口的动脉流入扩张性从4%增加到7%，动脉吻合后段（PAAS）扩张性从3%增加到4%。相反，流出静脉的扩张性从4%下降到2%。这些结果证实，除了直径的变化，血管段的机械性能在瘘成熟过程中发生了变化。这表明我们基于软件的方法可以使基于超声的机械测量变得更容易用于更广泛的临床研究。
Vascular access is essential for hemodialysis patients. The mature native arteriovenous fistula has been the preferred vascular access for hemodialysis because it has greater longevity than synthetic grafts. However, once surgically created, fistulas often fail to develop (mature) into viable points of vascular access, requiring surgical or radiologic interventions before their use. Since maturation depends on vascular mechanics (e.g., distensibility and wall shear), we developed open-source ultrasound software to investigate these metrics clinically. We demonstrated in a single patient the ability of the software for consistent measurements from various locations within a cardiac cycle and between different cardiac cycles. We further assessed the ability of the software to identify changes in distensibility of a patient’s fistula from one to six weeks post-operation. The routine frame rates of clinical machines demonstrated high fidelity tracking within cardiac cycles (coefficient of variation (CV) = 2.4% ± 0.011) and between cardiac cycles (CV = 2.4% ± 0.004). The distensibility of the patient’s fistula from one to six weeks post-operation increased from 4% to 7% in the arterial inflow and from 3% to 4% in the post arterial anastomotic segment (PAAS). In contrast, the distensibility of the outflow vein decreased from 4% to 2%. These results corroborate that in addition to diameter changes, the mechanical properties of the vascular segments changed during fistula maturation. This demonstrates that our software based approach may allow ultrasound based mechanical measurements to become more accessible for wider clinical research.