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内瘘成熟R21：NIH Pi：William Weitzel，MD co-I：Albert Shih，PhD，Grant Kruger，Matthew Leavitt，Peter Henke摘要血管通路对血液透析患者的必要治疗至关重要。由于它们的可靠性，寿命， 随着并发症发生率的降低，自体动静脉瘘--通过手术在动脉和静脉之间建立连接--比其他形式的血管通路日益突出。然而，与瘘管成熟相关的不确定性已经给已经在接受重大医疗程序的患者带来了不必要的成本、风险和压力。目前尚无系统能直接、无创地测量瘘管成熟过程中血管重塑的潜在原因。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来识别血管壁边缘，并在心脏周期中测量血管大小、弹性特性和血壁剪切率。在体外(通过对简单和真实的瘘管几何形状的体模研究)和体内验证该工具后 (对小样本血液透析患者在瘘管形成之前和之后进行的试点研究)，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。该软件工具将用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。鉴于超声成像的无处不在和非侵入性，以及我们计划发布该工具的广泛开放访问，该建议可以从根本上加快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.