Point of Care Elastographic Sonoangiography (eSA)

护理点弹性超声血管造影 (eSA)

• 批准号: 9393446
• 负责人: William F Weitzel
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-10-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9393446
• 关键词: Activities of Daily Living; Algorithms; Anastomosis - action; Anatomy; Angiography; Angioplasty; Arteries; Arteriovenous fistula; Blood; Blood Vessels; Breast; Caliber; Cardiac; Cerebral Arterial Diseases; Cerebrovascular Disorders; Chronic Kidney Failure; Clinical; Clinical Research; Complication; Computer software; Data; Diagnosis; Diagnostic; Diagnostic Procedure; Dialysis procedure; Disabled Persons; Elasticity; End stage renal failure; Fistula; Foundations; Functional disorder; Future; Geometry; Goals; Gold; Health; Health Care Costs; Health Services Accessibility; Hemodialysis; Image; Impairment; In Vitro; Intervention; Kidney Failure; Life; Limb structure; Location; Longevity; Longitudinal observational study; Manufacturer Name; Measurement; Measures; Mechanics; Medical; Medical Care Costs; Medicine; Methods; Morbidity - disease rate; Motion; Nature; Observational Study; Operative Surgical Procedures; Patients; Perioperative; Peripheral; Peripheral Vascular Diseases; Physiological; Population; Postoperative Period; Prevalence; Procedures; Property; Psychological Stress; Quality of life; Recovery of Function; Research; Research Personnel; Resolution; Risk; Second Look Surgery; Software Tools; Stimulus; Stress; Structure; System; Technology; Three-Dimensional Imaging; Tissues; Transducers; Ultrasonography; Uncertainty; Vascular System; Vascular remodeling; Veins; Veterans; base; clinical application; cost; elastography; high risk; image processing; image reconstruction; imaging system; improved; in vivo; mortality; open source; point of care; reconstruction; software systems; success; temporal measurement; tool; vascular sonography

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.

抽象的 我们国家的退伍军人患有死亡率和 发病率极高。 CKD发展为终阶段肾脏疾病（ESRD）是一种残疾状态 导致需要每周三次血液透析以维持生命的患者。功能独立性 血液透析需要可靠且功能良好的血管通道才能连接到透析机 治疗。血管进入对于血液透析患者所需的治疗至关重要。由于他们 可靠性，寿命和较低的并发症发生率，自动静脉瘘 - 手术创建 动脉与静脉之间的联系 - 在其他形式的血管中变得越来越突出 使用权。但是，与瘘管成熟相关的不确定性导致了不明的成本，风险和压力 患者已经接受了重要的医疗程序。此外，透析单元中的瘘管功能障碍 阻碍了稳定的有效透析，除了增加成本外，还会在患者身上造成无情的心理压力 医疗保健。目前尚无系统直接和无创的，衡量的根本原因 瘘管成熟过程中的血管重塑，或在瘘管成熟时提供全面的瘘管功能障碍的诊断 床头。我们建议建立和临床验证超声诊断平台 - 称为 护理弹性声 - 单血管造影（ESA）的临时和空间分辨率 识别船只壁边缘并测量血管尺寸，弹性特性和心脏剪切速率 在护理点上的血管解剖结构的周期和3D映射。验证此工具后都在体外 （通过对简单且现实的瘘管几何形状的幻影研究）和体内（临床研究 血液透析患者前后创建前后，我们计划将软件作为开放平台工具发布 对于研究人员。该软件工具将有助于术前计划和术后评估 手术和手术修订的指导决策。鉴于超声的普遍性和无创性 成像和我们计划释放此工具的广泛开放访问，该建议可以从根本上加速 安全有效的超声诊断方法进行瘘管优化。另外，给定推广性 对于其他外围血管系统（颈动脉，四肢），该系统有可能优化血管 诊断，从而提高了患有外围和脑的退伍军人的功能能力 动脉疾病。通过在透析瘘设置中验证这项技术，该项目将奠定基础 对于进一步的临床研究，将来适用于扩大血管医学的临床指示。