Point of Care Elastographic Sonoangiography (eSA)

摘要 我国退伍军人患慢性肾脏病(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)是一种致残状态 导致患者每周需要进行三次血液透析以维持生命。上的功能独立性 血液透析需要可靠和功能良好的血管通路才能连接到透析机 治疗。血管通路对血液透析患者的必要治疗至关重要。由于他们的 手术建立的自体动静脉瘘的可靠性、寿命和较低的并发症发生率 动脉和静脉之间的连接-比其他形式的血管越来越突出 进入。然而，与瘘管成熟相关的不确定性已经造成了不必要的成本、风险和压力 已经在接受重大医疗程序的患者。此外，透析单元中的瘘管功能障碍 阻碍稳定有效的透析，给患者造成不必要的心理压力，此外还增加了成本 医疗保健方面的。目前还没有系统可以直接和非侵入性地测量 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。 在床边。我们建议建立一个超声诊断平台并进行临床验证--称为The Point 护理弹性声学血管成像(ESA)具有前所未有的时间和空间分辨率 在心脏手术中识别血管壁边缘并测量血管大小、弹性性质和血壁剪切率 循环，以及护理点血管解剖的3D映射。在体外验证该工具之后 (通过对简单和现实的瘘管几何形状的体模研究)和活体(在 血液透析患者造瘘前后)，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计划和术后评估 指导血管成形术和外科翻修的决定。鉴于超声波的无处不在和非侵入性 映像和我们计划发布此工具的广泛开放访问，此提议可以从根本上加速 安全有效的内瘘超声诊断方法优化。此外，鉴于可概括性， 对于其他外周血管系统(颈动脉、四肢)，该系统具有优化血管的潜力 诊断，从而提高患有外周和脑疾病的退伍军人的功能能力 动脉疾病。通过在透析内瘘环境中对该技术的验证，为本项目奠定了基础 为今后进一步的临床研究，扩大血管内科的临床适应证提供参考。

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.