Optimization of Dialysis Fistula Maturation via Vascular Ultrasound Elasticity an

描述（由申请人提供）：通过血管超声弹性和剪切率成像优化透析瘘成熟R21：NIH PI：William Weitzel，MD Co-I：Albert Shih，PHD，Grant Kruger，Matthew Leavitt，Peter Henke摘要血管通路对于血液透析患者的必要治疗至关重要。由于其可靠性，寿命长， 和较低的并发症发生率，自体动静脉瘘--通过外科手术在动脉和静脉之间建立连接--相对于其他形式的血管通路变得越来越突出。然而，与瘘管成熟相关的不确定性已经对已经经历重要医疗程序的患者造成了过度的成本、风险和压力。目前还没有一个系统可以直接和无创地测量瘘管成熟过程中血管重塑的根本原因。我们建议建立一个超声软件工具箱-被称为血管超声弹性成像和剪切率（VUESR）成像-具有前所未有的时间和空间分辨率，以识别血管壁边缘和测量血管尺寸，弹性特性和血管壁剪切率在心动周期。在体外（通过对简单和真实瘘管几何形状的体模研究）和体内验证该工具后， （一项在建立瘘管前后对血液透析患者的小样本进行的试点研究），我们计划在公共领域发布这项技术所需的软件，作为研究人员的开放平台工具。该软件工具将有助于术前计划和术后评估，以指导血管成形术和手术翻修的决策。鉴于超声成像的普遍性和非侵入性，以及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安全有效的超声诊断方法，以优化瘘管。

DESCRIPTION (provided by applicant): Optimization of Dialysis Fistula Maturation via Vascular Ultrasound Elasticity and Shear Rate Imaging R21: NIH PI: William Weitzel, MD Co-I: Albert Shih, PHD, Grant Kruger, Matthew Leavitt, Peter Henke Abstract 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. Currently no system exists to directly and noninvasively measure the underlying causes of vascular remodeling during fistula maturation. We propose to build an ultrasound software toolbox - referred to as the vascular ultrasound elastography and shear rate (VUESR) imaging - 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. After validating thi tool both in vitro (through phantom studies on simple and realistic fistula geometries) and in vivo (a pilot study conducted on a small sample of hemodialysis patients pre- and post-fistula creation), we plan to release the software necessary for this technique available in the public domain 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.