Role of intravascular ultrasound in Central Venous Stenosis in ESRD patients

血管内超声在 ESRD 患者中心静脉狭窄中的作用

• 批准号: 9896231
• 负责人: Vipul C Chitalia
• 金额: $ 23.9万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9896231
• 关键词: Address; Affect; Angiography; Angioplasty; Area; Blood Vessels; Calcium; Catheters; Central Vein; Clinical; Custom; Data; Development; Diagnosis; Diagnostic; Dialysis procedure; Disease; Dissection; End stage renal failure; Exposure to; Future; Goals; Grant; Hemodialysis; Histology; Image Analysis; Imaging Techniques; Internal jugular vein structure; Intervention; Intervention Studies; Knowledge; Laboratories; Lesion; Lesion by Morphology; Life; Limb structure; Maps; Methods; Mind; Modality; Morphology; Outcome; Patients; Phlebography; Pilot Projects; Process; Role; Seeds; Severities; Shapes; Signal Transduction; Site; Stenosis; Structure; Structure of subclavian vein; Superior vena cava structure; Surgeon; Techniques; Therapeutic; Therapeutic Intervention; Thinness; Ultrasonography; United States; Variant; Vascular Diseases; Veins; Venous; Work; base; calcification; design; improved; multidisciplinary; post intervention; predicting response; primary outcome; radio frequency; radiologist; respiratory; response; secondary outcome; standard of care; success; virtual

Project Summary Central venous stenosis (CVS) involves any one of the central veins such as subclavian, brachiocephalic and internal jugular veins, and superior vena cava in the patients with end stage renal disease. CVS is an important clinical problem as it currently affects 15-50% of ESRD patients and is thought to be responsible for 21-50% cases of vascular access malfunction. Both the diagnostic and the therapeutic landscapes of CVS represent areas of unmet need. Contrast venography is the standard-of-care for diagnosing CVS. However, this approach has several limitations including inaccurate determination of the extent of stenosis. In other clinical settings, the management of venous stenosis is increasingly influenced by the morphology of stenotic lesions. But venography fails to provide this information. While the endovascular interventions for CVS have encouraging short-term success rates, its long-term unassisted patency rates remain dismal. These interventions even increase the progression of the stenotic lesions in some cases. Currently, there are no methods for predicting which lesions are likely to improve or undergo accelerated progression from the intervention, and this represents a major knowledge gap in this area. An overarching objective of this project is to gain a deeper understanding of the types of lesions constituting CVS and their responses to the endovascular interventional therapies. This information will guide the development of a strategy to customize the intervention for those lesions that is likely to yield maximum therapeutic benefit. This pilot proposal represents an initial step towards this objective and explores the use of Intravascular ultrasound (IVUS) to overcome limitations of venography. IVUS uses radiofrequency ultrasound backscatter data to detect stenotic venous lesions. Image analysis will provide the morphological composition of the lesions. Aim 1 of this pilot study will compare venography to IVUS in detecting CVS to obtain a preliminary sensitivity of IVUS. Aim 2 will classify and map the morphology of stenotic lesions. The results from this pilot study will guide sufficiently powered future studies to demonstrate the superiority of IVUS compared to venography in diagnosing CVS. It will also seed interventional studies where the response to angioplasty will be compared based on the morphology of CVS lesions.

项目摘要 中央静脉狭窄（CVS）涉及任何一种中央静脉 和颈部静脉内部静脉静脉静脉静脉静脉疾病患者。简历是一个 重要的临床问题，因为它目前会影响15-50％的ESRD患者，并且被认为是负责任的 对于21-50％的血管通道故障。诊断和治疗景观 简历代表未满足需求的领域。造影剂静脉曲张是诊断CVS的护理标准。 但是，这种方法有几个局限性，包括对狭窄程度的确定不准确。 在其他临床环境中，静脉狭窄的管理受形态的影响越来越多 狭窄病变。但是静脉曲张无法提供此信息。而血管内干预 对于简历具有令人鼓舞的短期成功率，其长期无助的通畅率仍然令人沮丧。 在某些情况下，这些干预措施甚至会增加狭窄病变的进展。目前，那里 没有预测哪些病变可能会改善或经历加速进展的方法 干预措施，这代表了这一领域的主要知识差距。 该项目的总体目标是对病变类型有更深入的了解 构成简历及其对血管内介入疗法的反应。这些信息将 指导制定一项策略，以自定义可能产生的病变的干预措施 最大的治疗益处。该试点建议是朝着这一目标的第一步， 探索血管内超声（IVU）的使用来克服静脉造影的局限性。 IVUS使用 射频超声反向散射数据可检测狭窄的静脉病变。图像分析将提供 病变的形态组成。该试点研究的目标1将比较静脉造影与IVU 检测CVS获得IVU的初步灵敏度。 AIM 2将对并映射的形态 狭窄的病变。这项试验研究的结果将指导足够有能力的未来研究 与诊断CV中的静脉相比，证明了IVU的优越性。它也会播种 介入的研究将根据对血管成形术的反应根据形态进行比较 CVS病变。