Point of Care Elastographic Sonoangiography (eSA)

护理点弹性超声血管造影 (eSA)

• 批准号: 9768247
• 负责人: William F Weitzel
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768247
• 关键词: 3-Dimensional; Activities of Daily Living; Algorithms; Anastomosis - action; Anatomy; Angiography; Angioplasty; Arteries; Arteriovenous fistula; Blood; Blood Vessels; Breast; Caliber; Cardiac; Cerebral Arterial Diseases; Cerebrovascular Disorders; Chronic Kidney Failure; Clinical; Clinical Research; Complication; Computer software; Data; Diagnosis; Diagnostic; Diagnostic Procedure; Dialysis procedure; Disabled Persons; Elasticity; End stage renal failure; Fistula; Foundations; Functional disorder; Future; Geometry; Goals; Gold; Health; Health Care Costs; Health Services Accessibility; Hemodialysis; Image; Impairment; In Vitro; Intervention; Kidney Failure; Life; Limb structure; Location; Longevity; Longitudinal observational study; Manufacturer Name; Measurement; Measures; Mechanics; Medical; Medical Care Costs; Medicine; Methods; Morbidity - disease rate; Motion; Nature; Observational Study; Operative Surgical Procedures; Patients; Perioperative; Peripheral; Peripheral Vascular Diseases; Physiological; Population; Postoperative Period; Prevalence; Procedures; Property; Psychological Stress; Quality of life; Recovery of Function; Research; Research Personnel; Resolution; Risk; Second Look Surgery; Software Tools; Stimulus; Stress; Structure; System; Technology; Three-Dimensional Imaging; Tissues; Transducers; Ultrasonography; Uncertainty; Vascular System; Vascular remodeling; Veins; Veterans; base; clinical application; cost; elastography; functional independence; high risk; image processing; image reconstruction; imaging system; improved; in vivo; mortality; open source; point of care; reconstruction; software systems; success; temporal measurement; tool

ABSTRACT Our nation’s veterans are at a high risk for developing Chronic Kidney Disease (CKD) with rates of mortality and morbidity that are extremely high. CKD progressing to End Stage Renal Disease (ESRD) is a disabling condition resulting in patients requiring hemodialysis thrice weekly to maintain life. Functional independence on hemodialysis requires a reliable and well-functioning vascular access to connect to the dialysis machine for treatments. Vascular access is crucial to the treatments necessary for hemodialysis patients. Due to their reliability, longevity, and lower complication rates, autogenous arteriovenous fistulas – surgically created connections between arteries and veins – have become increasingly prominent over other forms of vascular access. However, the uncertainty associated with fistula maturation has caused undue cost, risk, and stress to patients already undergoing significant medical procedures. Furthermore, fistula dysfunction in the dialysis unit impedes stable effective dialysis, creates undue psychological stress in patients, in addition to increasing the cost of medical care. Currently no system exists to directly and noninvasively measure the underlying causes of vascular remodeling during fistula maturation, or provides comprehensive diagnosis of fistula dysfunction at the bedside. We propose to build and clinically validate an ultrasound diagnostic platform – referred to as the Point of Care Elastographic Sono-Angiography (eSA) that has unprecedented temporal and spatial resolution to identify vessel wall edges and measure vessel size, elastic properties, and blood-wall shear rate during the cardiac cycles, and 3D mapping of the vascular anatomy at the point of care. After validating this tool both in vitro (through phantom studies on simple and realistic fistula geometries) and in vivo (clinical study conducted on hemodialysis patients pre- and post-fistula creation), we plan to release the software as an open platform tool for researchers. This software tool will be useful for pre-operative planning and post-operative assessment to guide decisions for angioplasty and surgical revision. Given the ubiquity and noninvasive nature of ultrasound imaging and the broad open access with which we plan to release this tool, this proposal can radically accelerate safe and effective ultrasound diagnostic methods for fistula optimization. In addition, given the generalizability to other peripheral vascular systems (carotid, extremities) this system has the potential to optimize vascular diagnostics and thereby improve the functional capacity of veterans suffering from peripheral and cerebral arterial disease. By validating this technology in the dialysis fistula setting, this project will lay the foundation for further clinical research applied to expanded clinical indications in vascular medicine in the future.

抽象的 我们国家的退伍军人患慢性肾病 (CKD) 的风险很高，死亡率和 发病率极高。 CKD 进展为终末期肾病 (ESRD) 是一种致残性疾病 导致患者需要每周三次血液透析来维持生命。功能独立于 血液透析需要可靠且功能良好的血管通路连接到透析机以进行血液透析 治疗。血管通路对于血液透析患者所需的治疗至关重要。由于他们的 可靠性、寿命长、并发症发生率低，自体动静脉瘘 – 通过手术创建 动脉和静脉之间的连接——比其他形式的血管变得越来越重要 使用权。然而，与瘘管成熟相关的不确定性导致了不适当的成本、风险和压力 已经接受重大医疗程序的患者。此外，透析室的瘘管功能障碍 阻碍稳定有效的透析，除了增加费用外，还给患者造成过度的心理压力 的医疗保健。目前还没有系统可以直接且无创地测量疾病的根本原因 瘘管成熟过程中的血管重塑，或提供瘘管功能障碍的综合诊断 床头。我们建议建立一个超声诊断平台并进行临床验证——称为 Point 护理弹性超声血管造影 (eSA) 具有前所未有的时间和空间分辨率 识别血管壁边缘并测量心脏骤停期间的血管尺寸、弹性特性和血壁剪切率 周期和护理点血管解剖结构的 3D 绘图。在体外验证该工具后 （通过对简单而真实的瘘管几何形状的模型研究）和体内（对 血液透析患者造瘘前和造瘘后），我们计划将该软件作为开放平台工具发布 对于研究人员来说。该软件工具将有助于术前规划和术后评估 指导血管成形术和手术修复的决策。鉴于超声波的普遍性和非侵入性 成像和我们计划发布该工具的广泛开放访问，该提案可以从根本上加速 用于优化瘘管的安全有效的超声诊断方法。另外，考虑到普遍性 与其他外周血管系统（颈动脉、四肢）相比，该系统具有优化血管的潜力 诊断，从而提高患有外周和脑部疾病的退伍军人的功能能力 动脉疾病。通过在透析瘘管环境中验证该技术，该项目将为该项目奠定基础 进一步的临床研究应用于未来扩大血管医学的临床适应症。