OBJECTIVES:Successful hemodialysis requires reliable vascular access that can deliver adequate blood flow. An arteriovenous fistula is preferred for access because of its longevity and low frequency of complications, but up to 60% of arteriovenous fistulas created surgically are never suitable for hemodialysis because of nonmaturation (insufficient vascular dilatation). Decreased arterial elasticity may impair dilatation, thereby affecting fistula maturation. This study evaluated the feasibility of brachial artery elasticity measurement in patients with chronic kidney disease obtained during routine pre-operative mapping ultrasound (US) imaging before hemodialysis access placement and compared the measurements to those obtained in healthy volunteers. METHODS:Brachial artery functional US studies were collected from 75 patients undergoing routine preoperative mapping for hemodialysis access and 50 healthy volunteers. Vascular strain was calculated from the change in intima-media thickness between end systole and end diastole, and vascular stress was estimated from the pulse pressure. Assuming a linear elastic medium, the elastic modulus was estimated as the ratio of vascular stress to strain. RESULTS:Elastic modulus measurements were significantly higher in patients than in volunteers (130 versus 100 kPa; P = .01). With combined volunteer and patient data, there was a significant correlation between elasticity and systolic blood pressure (R2 = 0.23; P < .001). Elasticity was correlated with age in volunteers but not in patients (R2 = 0.14; P = .017; R2 < .001; P = .829, respectively). CONCLUSIONS:This analysis of clinical arterial vessel biomechanics shows that a noninvasive US measurement can detect elastic modulus differences between patients with chronic kidney disease and healthy individuals. Future studies will correlate the elastic modulus with histologic characteristics and eventual arteriovenous fistula maturation, which may provide supplemental information on arterial biomechanical properties as a useful addition to current predictors of fistula success.

译文

目的:成功的血液透析需要可靠的血管通路,以提供足够的血流量。动静脉瘘的使用寿命长且并发症发生频率低,因此首选进入,但由于不成熟(血管扩张不足),外科手术产生的动静脉瘘中多达60%永远不适合进行血液透析。动脉弹性下降可能会损害扩张,从而影响瘘管成熟。这项研究评估了在进行血液透析通路放置之前在常规术前作图超声(US)成像过程中获得的慢性肾脏病患者肱动脉弹性测量的可行性,并将测量结果与健康志愿者的测量结果进行了比较。
方法:从75例接受常规血液透析的术前作图的患者和50名健康志愿者收集了肱动脉功能性US研究。根据收缩末期与舒张末期之间内膜-中膜厚度的变化计算血管应变,并根据脉压估算血管压力。假设为线性弹性介质,则将弹性模量估计为血管应力与应变之比。
结果:患者的弹性模量测量值显着高于志愿者(130 vs 100 kPa; P = 0.01)。结合志愿者和患者的数据,弹性与收缩压之间存在显着相关性(R2 = 0.23; P <.001)。志愿者的弹性与年龄相关,而患者与年龄无关(R2 = 0.14; P = .017; R2 <.001; P = .829)。
结论:对临床血管生物力学的分析表明,无创超声测量可以检测出慢性肾脏病患者与健康个体之间的弹性模量差异。未来的研究将把弹性模量与组织学特征和最终动静脉瘘的成熟联系起来,这可能会提供有关动脉生物力学特性的补充信息,作为目前瘘管成功预测指标的有用补充。

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