Combined functional and anatomical diagnostic endpoints for assessing arteriovenous fistula dysfunction  

作　　者：Ehsan Rajabi-Jaghargh Rupak K Banerjee 

机构地区：[1]Mechanical Engineering Program,Department of Mechanical and Materials Engineering,University of Cincinnati,Cincinnati,OH 45221-0072,United States [2]Biomedical Engineering Program,Department of Biomedical,Chemical,University of Cincinnati,Cincinnati,OH 45221-0072,United States [3]Environmental Engineering,University of Cincinnati,Cincinnati,OH 45221-0072,United States [4]Cincinnati Veterans Administration Medical Center,Cincinnati,OH 45221-0072,United States

出　　处：《World Journal of Nephrology》2015年第1期6-18,共13页世界肾病学杂志（英文版）

摘　　要：Failure of arteriovenous fistulas(AVF) to mature and thrombosis in matured fistulas have been the major causes of morbidity and mortality in hemodialysis patients. Stenosis, which occurs due to adverse remodeling in AVFs, is one of the major underlying factors under both scenarios. Early diagnosis of a stenosis in an AVF can provide an opportunity to intervene in a timelymanner for either assisting the maturation process or avoiding the thrombosis. The goal of surveillance strategies was to supplement the clinical evaluation(i.e., physical examination) of the AVF for better and earlier diagnosis of a developing stenosis. Surveillance strategies were mainly based on measurement of functional hemodynamic endpoints, including blood flow(Q a) to the vascular access and venous access pressure(VAP). As the changes in arterial pressure(MAP) affects the level of VAP, the ratio of VAP to MAP(VAPR = VAP/MAP) was used for diagnosis. A Q a < 400-500 m L/min or a VAPR > 0.55 is considered sign of significant stenosis, which requires immediate intervention. However, due to the complex nature of AVFs, the surveillance strategies have failed to consistently detect stenosis under different scenarios. VAPR has been primarily developed to detect outflow stenosis in arteriovenous grafts, and it hasn't been successful in accurate diagnosis of outflow lesions in AVFs. Similarly, AVFs can maintain relatively high blood flow despite the presence of a significant outflow stenosis and thus, Q a has been found to be a better predictor of only inflow lesions. Similar shortcomings have been reported in the detection of functional severity of coronary stenosis using diagnostic endpoints that were based on either flow or pressure. This limitation has been associated with the fact that both pressure and flow change in the presence of a stenosis and thus, hemodynamic diagnostic endpoints that employ only one of these parameters are inherently prone to inaccuracies. Recent attempts have resulted in development of new diagnostic endpoints that canFailure of arteriovenous fistulas （AVF） to mature and thrombosis in matured fistulas have been the major causes of morbidity and mortality in hemodialysis patients. Stenosis, which occurs due to adverse remodeling in AVFs, is one of the major underlying factors under both scenarios. Early diagnosis of a stenosis in an AVF can provide an opportunity to intervene in a timely manner for either assisting the maturation process or avoiding the thrombosis. The goal of surveillance strategies was to supplement the clinical evaluation （ i.e. , physical examination） of the AVF for better and earlier diagnosis of a developing stenosis. Surveillance strategies were mainly based on measurement of functional hemodynamic endpoints, including blood flow （Qa） to the vascular access and venous access pressure （VAP）. As the changes in arterial pressure （MAP） affects the level of VAP, the ratio of VAP to MAP （VAPR = VAP/MAP） was used for diagnosis. A Qa 〈 400-500 mL/min or a VAPR 〉 0.55 is considered sign of significant stenosis, which requires immediate intervention. However, due to the complex nature of AVFs, the surveillance strategies have failed to consistently detect stenosis under different scenarios. VAPR has been primarily developed to detect outflow stenosis in arteriovenous grafts, and it hasn’t been successful in accurate diagnosis of outflow lesions in AVFs. Similarly, AVFs can maintain relatively high blood flow despite the presence of a significant outflow stenosis and thus, Qa has been found to be a better predictor of only inflow lesions. Similar shortcomings have been reported in the detection of functional severity of coronary stenosis using diagnostic endpoints that were based on either flow or pressure. This limitation has been associated with the fact that both pressure and flow change in the presence of a stenosis and thus, hemodynamic diagnostic endpoints that employ only one of these parameters are inherently prone to inaccuracies. Recent attempts have resulted in development o

关 键 词：Arteriovenous fistula Dysfunctional arte-riovenous fistulas STENOSIS Surveillance Flow rate Pressure 

分 类 号：R654.3[医药卫生—外科学] R543[医药卫生—临床医学]