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.

项目概要 中央静脉狭窄（CVS）涉及任何一根中央静脉，如锁骨下静脉、头臂静脉 终末期肾病患者的颈内静脉和上腔静脉。 CVS 是一个 重要的临床问题，因为它目前影响 15-50% 的 ESRD 患者，并被认为是造成这一问题的原因 21-50% 的血管通路故障病例。诊断和治疗领域 CVS 代表未满足需求的领域。对比静脉造影是诊断 CVS 的标准治疗方法。 然而，这种方法有一些局限性，包括狭窄程度的确定不准确。 在其他临床环境中，静脉狭窄的治疗越来越受到形态的影响 的狭窄病变。但静脉造影无法提供此信息。虽然血管内介入治疗 尽管 CVS 具有令人鼓舞的短期成功率，但其长期无协助通畅率仍然令人沮丧。 在某些情况下，这些干预措施甚至会加速狭窄病变的进展。目前，有 没有方法可以预测哪些病变可能会改善或加速进展 干预，这代表了该领域的重大知识差距。 该项目的首要目标是更深入地了解病变类型 CVS 的构成及其对血管内介入治疗的反应。该信息将 指导制定策略，针对可能产生影响的病变定制干预措施 最大的治疗效益。该试点提案是实现这一目标的第一步， 探索使用血管内超声（IVUS）来克服静脉造影的局限性。血管内超声用途 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 IVUS 检测CVS以获得IVUS的初步灵敏度。目标 2 将分类并绘制形态图 狭窄病变。这项试点研究的结果将指导未来的研究 证明 IVUS 与静脉造影在诊断 CVS 方面的优越性。也会播种 介入研究，根据血管成形术的形态来比较血管成形术的反应 CVS 病变。