Role of intravascular ultrasound in Central Venous Stenosis in ESRD patients

项目摘要 中心静脉狭窄（CVS）涉及任何一条中心静脉，如锁骨下静脉、头臂静脉 终末期肾病患者的颈内静脉和上级腔静脉。CVS是一个 重要的临床问题，因为它目前影响15-50%的ESRD患者，并被认为是负责 21-50%的血管通路故障病例。无论是诊断还是治疗， CVS代表未满足需求的领域。静脉造影是诊断CVS的标准治疗方法。 然而，该方法具有若干限制，包括狭窄程度的不准确确定。 在其他临床环境中，静脉狭窄的管理越来越受到形态学的影响。 狭窄性病变但是静脉造影术不能提供这些信息。虽然血管内介入治疗 虽然CVS的短期成功率令人鼓舞，但其长期无辅助通畅率仍然令人沮丧。 在某些情况下，这些干预措施甚至会增加狭窄病变的进展。目前 没有方法预测哪些病变可能改善或经历加速进展， 干预措施，这是这一领域的一个重大知识差距。 这个项目的首要目标是更深入地了解病变的类型 血管内介入治疗的反应。这些信息将 指导制定策略，为可能产生的病变定制干预措施 最大的治疗效益。这一试点提案是实现这一目标的第一步， 探讨了血管内超声（IVUS）的使用，以克服静脉造影术的局限性。IVUS使用 射频超声背向散射数据检测狭窄静脉病变。图像分析将提供 病变的形态组成。本初步研究的目的1将比较静脉造影与IVUS， 检测CVS以获得IVUS的初步灵敏度。目标2将分类和映射的形态 狭窄病变这项试点研究的结果将为未来的研究提供足够的指导， 证明IVUS在诊断CVS方面优于静脉造影。它也会播种 介入性研究，其中将根据血管成形术的形态比较血管成形术的反应。 CVS病变。

Project Summary Central venous stenosis (CVS) involves any one of the central veins such as subclavian, brachiocephalic and internal jugular veins, and superior vena cava in the patients with end stage renal disease. CVS is an important clinical problem as it currently affects 15-50% of ESRD patients and is thought to be responsible for 21-50% cases of vascular access malfunction. Both the diagnostic and the therapeutic landscapes of CVS represent areas of unmet need. Contrast venography is the standard-of-care for diagnosing CVS. However, this approach has several limitations including inaccurate determination of the extent of stenosis. In other clinical settings, the management of venous stenosis is increasingly influenced by the morphology of stenotic lesions. But venography fails to provide this information. While the endovascular interventions for CVS have encouraging short-term success rates, its long-term unassisted patency rates remain dismal. These interventions even increase the progression of the stenotic lesions in some cases. Currently, there are no methods for predicting which lesions are likely to improve or undergo accelerated progression from the intervention, and this represents a major knowledge gap in this area. An overarching objective of this project is to gain a deeper understanding of the types of lesions constituting CVS and their responses to the endovascular interventional therapies. This information will guide the development of a strategy to customize the intervention for those lesions that is likely to yield maximum therapeutic benefit. This pilot proposal represents an initial step towards this objective and explores the use of Intravascular ultrasound (IVUS) to overcome limitations of venography. IVUS uses radiofrequency ultrasound backscatter data to detect stenotic venous lesions. Image analysis will provide the morphological composition of the lesions. Aim 1 of this pilot study will compare venography to IVUS in detecting CVS to obtain a preliminary sensitivity of IVUS. Aim 2 will classify and map the morphology of stenotic lesions. The results from this pilot study will guide sufficiently powered future studies to demonstrate the superiority of IVUS compared to venography in diagnosing CVS. It will also seed interventional studies where the response to angioplasty will be compared based on the morphology of CVS lesions.