Role of intravascular ultrasound in Central Venous Stenosis in ESRD patients

项目摘要 中心静脉狭窄(CVS)累及锁骨下静脉、头臂静脉等任何一条中央静脉。 终末期肾病患者的颈内静脉、上腔静脉。CVS是一种 一个重要的临床问题，因为它目前影响着15%-50%的终末期肾病患者，并被认为是 对于21-50%的血管通路故障病例。诊断和治疗方面的情况 履历代表着未得到满足的需求领域。对比静脉造影是诊断脑血管痉挛的标准方法。 然而，这种方法有几个局限性，包括对狭窄程度的不准确确定。 在其他临床环境中，静脉狭窄的处理越来越受形态的影响。 狭窄的病变。但静脉造影术未能提供这一信息。而血管内介入治疗 由于CVS的短期成功率令人鼓舞，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，有 没有方法预测哪些病变可能改善或经历加速进展 干预，这代表着这一领域的重大知识鸿沟。 这个项目的主要目标是更深入地了解病变的类型。 CVS的构成及其对血管内介入治疗的反应。此信息将 指导制定战略，为那些可能产生的病变定制介入治疗 最大限度地提高治疗效益。这一试点提案是朝着这一目标迈出的第一步， 探讨血管内超声(IVUS)的使用，以克服静脉造影的局限性。静脉内超声使用 射频超声背向散射数据检测静脉狭窄病变。图像分析将提供 病变的形态成分。这项初步研究的目标1将比较静脉造影和静脉内超声 检测CVS以获得IVUS的初步敏感性。目标2将分类和绘制形态图 狭窄的病变。这项先导性研究的结果将指导未来的研究 证明静脉内超声在诊断脑血管痉挛方面的优越性。它还将播下种子 根据血管成形术的形态对血管成形术的反应进行比较的介入研究 血管痉挛损害。

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.