Hemodynamic Quantitative Analysis Based on Doppler Ultrasound for Arteriovenous Shunt Stenosis Screening

Jian-Xing Wu,Hsiao-Chuan Liu,Pi-Yun Chen,Shigao Chen,K Kirk Shung,Chia-Hung Lin

doi:10.1109/access.2019.2955742

Abstract

Clinically, arteriovenous shunt (AVS) stenosis results in turbulent and pulsatile flow because of high resistance and pressure within a narrowed space inside a stenotic access. Palpation and ultrasound methods are primarily used (first-line examination) to rapidly screen the risk of the degree of stenosis (DOS). Therefore, quantitative hemodynamic analysis involving Doppler ultrasound is performed in patients suffering from AVS stenosis and undergoing long-term hemodialysis. Doppler ultrasound with a center frequency of 7.5 MHz can provide substantial resolution and sensitivity to the measurement of blood flow velocity within a range of depth of 20.0-30.0 mm and a scan diameter of 10.0 mm. A hemodynamic method is used to analyze blood flow through a hemodialysis access in terms of dimensionless numbers. In this study, velocities were measured using Doppler ultrasound at three specific sites in vessels, namely, arterial anastomosis, loop, and venous anastomosis sites. Dimensionless numbers, such as supracritical Reynolds numbers, critical peak Reynolds numbers, and resistive indices, are determined in accordance with parallel conditional expression-based rules to create decision trees for the rapid screening of the DOS at the abovementioned specific sites. For the enrolled subjects, results demonstrate that noninvasive hemodynamic analysis with Doppler ultrasound measurements and parallel decision trees has potential for the efficient screening of the DOS in patients suffering from AVS stenosis and undergoing long-term hemodialysis. Experimental results also indicate that the hit and true-positive rates of the proposed screening method in clinical indication are higher than those of the machine learning method.

Highlights

End-stage renal disease (ESRD) is irreversible, and it is a major factor in the health-related morbidity and mortality of patients with cardiovascular disease or diabetes [1]
Our proposed system with the supracritical Reynolds number and the resistive index had an accuracy of 90%
The results demonstrated that the supracritical Reynolds number and the resistive index determined for evaluating the degree of stenosis (DOS) were a promising noninvasive procedure to efficiently screen and classify the DOS in patients suffering from arteriovenous shunt (AVS) stenosis and undergoing long-term hemodialysis

Summary

Introduction

End-stage renal disease (ESRD) is irreversible, and it is a major factor in the health-related morbidity and mortality of patients with cardiovascular disease or diabetes [1]. Patients with ESRD are treated with hemodialysis, peritoneal dialysis, or kidney transplant. Arteriovenous shunt (AVS) stenosis is caused by either inadequate arterial inflow or venous outflow occlusion [2]. Repeated puncturing of an arteriovenous access or long-term use can cause thrombosis, resulting in intimal hyperplasia, chronic fibrin and cellular deposition, or aneurysm formation. The narrowing of the interior of a dialysis access (>50% narrowing of the lumen diameter) increases the stress on the vascular wall and produces vibration, turbulent flow, and high-pressure pulsatile flow. In transposition fistulas (arteriovenous fistula [AVF]), the usual stenosis site is on the venous side; in polytetrafluoroethylene graft shunts (arteriovenous graft [AVG]), stenosis and subsequent thrombosis occur at the site of the graft-to-vein anastomosis [3].

Objectives

Methods

Results