Advanced ultrasound applications for assessing arteriovenous fistula surgery outcomes in end stage renal failure
File(s)
Author(s)
Faqihi, Wael Ali H.
Type
Thesis
Abstract
Arteriovenous fistulas (AVFs) are vital for delivering haemodialysis, but 25-60% of newly created AVF fail to mature, posing a challenge for predicting AVF maturation outcomes. This study investigates arterial stiffness and endothelial dysfunction's role in AVF maturation using advanced measurement techniques:2DShear Wave Elastography(2DSWE), 2DStrain Speckle Tracking(2DSST), Laser Doppler Flowmetry(LDF), and Flow-mediated Dilation(FMD). Additionally, it examines intraoperative blood volume flow(BVF) cutoff values for predicting AVF maturation using Transonic vascular flow probes.
Method: Prospective cohort observational study, a total of 76 end-stage renal failure patients were recruited who subsequently underwent AVF surgery. Before the AVF surgery, US vein mapping was performed. Then 2DSWE and 2DSST were conducted to assess arterial stiffness. FMD and LDF were applied to assess endothelial function indirectly via post reactive hyperaemia on day zero. Of 76 participant, 42 patients had intraoperative BVF measurement. Subsequently, patients were followed up for 6 weeks.
Results: showed a 22% AVF failure episode, with cohort average age 55 years, 75% male, and average BMI 27.14. Hypertension, diabetes, and cardiovascular disease occurred in 80.3%, 31.6%, and 32.9%, respectively, with significantly higher diabetes prevalence in the failure group (82.4% vs 17.6%).2DSWE readings were higher in failure group (3.88±0.18 m/s vs 3.75±0.15 m/s, p=0.01).For 2DSST, mature group had higher global circumferential(1.14±0.017%, p=0.016) and radial strain (1.18±0.037%, p=0.009). Mature group had significantly higher LDF(21.33±1.31 A.U., p=0.003) and FMD(9.60±1.40%, p=0.011) compared to the failure group (20.24±1.28 A.U.; 8.15±2.05%). BVF was lower in the failure group(p<0.001) with Cut-off values: 217 mL/min(brachiocephalic) and 127 mL/min(radiocephalic). AVF prediction model had good performance AUC-ROC:0.83.
Conclusion: advanced measurement techniques offer encouraging avenue for investigating arterial properties and predicting AVF maturation. Intraoperative BVF measurement is a strong indicator for immediate maturation outcomes, guiding potential AVF revisions or monitoring. Further research is required to validate the AVF prediction model's reliability in larger clinical trials.
Method: Prospective cohort observational study, a total of 76 end-stage renal failure patients were recruited who subsequently underwent AVF surgery. Before the AVF surgery, US vein mapping was performed. Then 2DSWE and 2DSST were conducted to assess arterial stiffness. FMD and LDF were applied to assess endothelial function indirectly via post reactive hyperaemia on day zero. Of 76 participant, 42 patients had intraoperative BVF measurement. Subsequently, patients were followed up for 6 weeks.
Results: showed a 22% AVF failure episode, with cohort average age 55 years, 75% male, and average BMI 27.14. Hypertension, diabetes, and cardiovascular disease occurred in 80.3%, 31.6%, and 32.9%, respectively, with significantly higher diabetes prevalence in the failure group (82.4% vs 17.6%).2DSWE readings were higher in failure group (3.88±0.18 m/s vs 3.75±0.15 m/s, p=0.01).For 2DSST, mature group had higher global circumferential(1.14±0.017%, p=0.016) and radial strain (1.18±0.037%, p=0.009). Mature group had significantly higher LDF(21.33±1.31 A.U., p=0.003) and FMD(9.60±1.40%, p=0.011) compared to the failure group (20.24±1.28 A.U.; 8.15±2.05%). BVF was lower in the failure group(p<0.001) with Cut-off values: 217 mL/min(brachiocephalic) and 127 mL/min(radiocephalic). AVF prediction model had good performance AUC-ROC:0.83.
Conclusion: advanced measurement techniques offer encouraging avenue for investigating arterial properties and predicting AVF maturation. Intraoperative BVF measurement is a strong indicator for immediate maturation outcomes, guiding potential AVF revisions or monitoring. Further research is required to validate the AVF prediction model's reliability in larger clinical trials.
Version
Open Access
Date Issued
2023-08-13
Date Awarded
2024-04-01
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Aslam, Dr Mohammed
Sponsor
Najran University
Royal Embassy of Saudi Arabia Cultural Bureau
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)