Cappelletti Sara, Caimi Alessandro, Caldiroli Alice, Baroni Irene, Votta Emiliano, Riboldi Stefania A, Marrocco-Trischitta Massimiliano M, Redaelli Alberto, Sturla Francesco
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.
Dialybrid Srl, Cantù, Italy.
Quant Imaging Med Surg. 2022 Jul;12(7):3515-3527. doi: 10.21037/qims-21-987.
Performance and durability of arterio-venous grafts depend on their ability to mimic the mechanical behavior of the anastomized blood vessels. To select the most suitable synthetic graft, evaluation of the radial deformability of peripheral arteries and veins could be crucial; however, a standardized non-invasive strategy is still missing. Herein, we sought to define a novel and user-friendly clinical protocol for assessment of the arm vessel deformability.
A dedicated protocol, applied on 30 volunteers, was specifically designed to estimate both compliance and distensibility of the brachial and radial arteries, and of the basilic and cephalic veins. Bi-dimensional ultrasound imaging was used to acquire cross-sectional areas (CSAs) of arteries in clinostatic configuration, and CSAs of veins combining clinostatic and orthostatic configurations. Arterial pulse pressure was measured with a digital sphygmomanometer, while venous hydrostatic pressure was derived from the arm length in orthostatic configuration.
For each participant, all CSAs were successfully extracted from ultrasound images. The basilic vein and the radial artery exhibited the largest (21.5±8.9 mm) and the smallest (3.4±1.0 mm) CSAs, respectively; CSA measurements were highly repeatable (Bland-Altman bias <10% and Pearson correlation ≥0.90, for both arteries and veins). In veins, compliance and distensibility were higher than in arteries; compliance was significantly higher (P<0.0001) in the brachial than in the radial artery (3.52×10 1.3×10 cm/mmHg); it was three times larger in basilic veins than in cephalic veins (17.4×10 5.6×10 cm/mmHg, P<0.0001).
The proposed non-invasive protocol proved feasible, effective and adequate for daily clinical practice, allowing for the estimation of patient-specific compliance and distensibility of peripheral arteries and veins. If further extended, it may contribute to the fabrication of biohybrid arterio-venous grafts, paving the way towards patient-tailored solutions for vascular access.
动静脉移植物的性能和耐用性取决于其模拟吻合血管机械行为的能力。为了选择最合适的合成移植物，评估外周动脉和静脉的径向可变形性可能至关重要；然而，一种标准化的非侵入性策略仍然缺失。在此，我们试图定义一种新颖且用户友好的临床方案，用于评估手臂血管的可变形性。
专门设计了一种应用于30名志愿者的专用方案，以估计肱动脉和桡动脉以及贵要静脉和头静脉的顺应性和扩张性。二维超声成像用于获取静息状态下动脉的横截面积（CSA），以及结合静息和直立状态的静脉CSA。用数字血压计测量动脉脉压，而静脉静水压力则根据直立状态下的手臂长度得出。
对于每位参与者，所有CSA均成功从超声图像中提取。贵要静脉和桡动脉的CSA分别最大（21.5±8.9平方毫米）和最小（3.4±1.0平方毫米）；CSA测量具有高度可重复性（动脉和静脉的布兰德-奥特曼偏差<10%，皮尔逊相关性≥0.90）。在静脉中，顺应性和扩张性高于动脉；肱动脉的顺应性显著高于桡动脉（3.52×10⁻¹.3×10⁻²平方厘米/毫米汞柱，P<0.0001）；贵要静脉的顺应性是头静脉的三倍（17.4×10⁻⁵.6×10⁻²平方厘米/毫米汞柱，P<0.0001）。结论：所提出的非侵入性方案在日常临床实践中被证明是可行、有效且充分的，能够估计患者特异性的外周动脉和静脉的顺应性和扩张性。如果进一步扩展，它可能有助于生物杂交动静脉移植物的制造，为血管通路的个性化解决方案铺平道路。
