Abstract
s Early clots and thrombosis to the progress of stenosis leading to arteriovenous shunt dysfunction occurs at the venous anastomsis site or the outflow vein. To prevent vascular access complications, such as inflow or outflow stenosis, this study proposes a computerized decision support system combining feature extraction methods and a non-cooperative game (NCG)-based decision-making model to evaluate arteriovenous shunt stenosis in clinical usages. Feature extraction methods, including the Burg autoregressive (AR) method and the fractional-order self-synchronization error formulation, are used to estimate the characteristic frequencies and to quantify the differences between the reference data and the routine examination data, in terms of the degree of stenosis (DOS). For 42 long-term follow-up patients, a less parameterized NCG model is then used to identify the possible level of stenosis. A novel screening model might be further built on an embedded system, for portable medical screening applications.
Highlights
IntroductionIn Taiwan, more than 77 thousand people require hemodialysis treatment and this number is increasing yearly
Chronic renal failure is an irreversible and progressive end-stage disease
A computer-assisted decision-making, including auscultation record, signal preprocessing, frequency spectral analysis, Table 2 shows the suggested screening rules, which are divided into five levels
Summary
In Taiwan, more than 77 thousand people require hemodialysis treatment and this number is increasing yearly. An arteriovenous access, such as Brescia-Cimino arteriovenous fistulas (AVFs) or politetrafluoroethylene grafts (AVGs), provides vital access for hemodialysis therapy. If there is repeated puncturing of this access (three days per week), narrowing of the access is caused by thrombosis, intimal hyperplasia, cellular deposits, or aneurysm. This produces turbulent flow, pulsatitle flow, inadequate arterial inflow, or venous outflow occlusion. Maintenance of proper function of the intra-graft blood flow (IBF), 600 - 1000 ml/min, is the most important issue for dialysis care, and the flow threshold should be < 600 ml/min for AVF and < 400 - 500 ml/min for AVG [1]
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