BIO5 Institute, University of Arizona, Tucson, AZ, USA.
BIO5 Institute, University of Arizona, Tucson, AZ, USA; Department of Electrical and Computer Engineering, College of Engineering, University of Arizona, Tucson, AZ, USA.
Comput Methods Programs Biomed. 2022 Jul;222:106938. doi: 10.1016/j.cmpb.2022.106938. Epub 2022 Jun 13.
Arteriovenous fistulae (AVF) are the preferred mode of hemodialysis vascular access and their successful maturation is critical to reduce patient morbidity, mortality, cost, and improve quality of life. Peri-anastomotic venous segment stenosis is the primary cause of AVF maturation failure. The objective is to develop a software protocol for the functional analysis of arteriovenous fistula.
We have developed a standard protocol for the anatomical analysis of the AVF to better understand the mechanisms involved in AVF stenosis and to identify future imaging biomarkers for AVF success or failure using non-contrast magnetic resonance imaging (MRI). The 3D model of the AVF is created using a polar dynamic programming technique. Analysis has been performed on six Yorkshire cross domestic swine, but techniques can be applied into clinical settings.
Differences in AVF angles and vein curvature are associated with significant variability of venous cross-sectional area. This suggests that the pattern of stenosis is likely to be dependent upon hemodynamic profiles which are largely determined by AVF anatomical features and could play an important role in AVF maturation.
This protocol enables us to visualize and study the hemodynamic profiles indirectly allowing early stratification of patients into high and low risk groups for AVF maturation failure. High risk patients could then be targeted with an enhanced process of care or future maturation enhancing therapies resulting in a much-needed precision-medicine approach to dialysis vascular access.
动静脉瘘（AVF）是血液透析血管通路的首选模式，其成功成熟对于降低患者发病率、死亡率、成本和提高生活质量至关重要。吻合口周围静脉段狭窄是 AVF 成熟失败的主要原因。目的是开发一种动静脉瘘功能分析的软件方案。
我们已经制定了 AVF 的解剖分析标准方案，以更好地了解 AVF 狭窄涉及的机制，并使用非对比磁共振成像（MRI）确定未来用于 AVF 成功或失败的成像生物标志物。使用极坐标动态编程技术创建 AVF 的 3D 模型。该技术已经在六只约克郡-cross 家猪中进行了分析，但也可以将技术应用于临床环境中。
AVF 角度和静脉曲率的差异与静脉横截面积的显著变化相关。这表明狭窄的模式可能取决于血流动力学特征，这些特征主要由 AVF 的解剖特征决定，并可能在 AVF 成熟中发挥重要作用。
该方案使我们能够可视化和研究血流动力学特征，从而可以间接对患者进行早期分层，将其分为 AVF 成熟失败的高风险和低风险组。高危患者可以通过增强的护理过程或未来的成熟增强治疗来靶向治疗，从而实现急需的透析血管通路精准医学方法。
