Non-invasive estimation of vascular compliance and distensibility in the arm vessels: a novel ultrasound-based protocol

Abstract

Background: Performance and durability of arterio-venous grafts depend on their ability to mimic the mechanical behavior of the anastomized blood vessels. To select the most suitable synthetic graft, in vivo evaluation of the radial deformability of peripheral arteries and veins could be crucial; however, a standardized non-invasive strategy is still missing. Herein, we sought to define a novel and user-friendly clinical protocol for in vivo assessment of the arm vessel deformability.Methods: A dedicated protocol, applied on 30 volunteers, was specifically designed to estimate both compliance and distensibility of the brachial and radial arteries, and of the basilic and cephalic veins. Bidimensional ultrasound imaging was used to acquire cross-sectional areas (CSAs) of arteries in clinostatic configuration, and CSAs of veins combining clinostatic and orthostatic configurations. Arterial pulse pressure was measured with a digital sphygmomanometer, while venous hydrostatic pressure was derived from the arm length in orthostatic configuration.Results: For each participant, all CSAs were successfully extracted from ultrasound images. The basilic vein and the radial artery exhibited the largest (21.5±8.9 mm 2 ) and the smallest (3.4±1.0 mm 2 ) CSAs, respectively; CSA measurements were highly repeatable (Bland-Altman bias <10% and Pearson correlation ≥0.90, for both arteries and veins). In veins, compliance and distensibility were higher than in arteries; compliance was significantly higher (P<0.0001) in the brachial than in the radial artery (3.52×10 −4 vs. 1.3×10 −4 cm 2 /mmHg); it was three times larger in basilic veins than in cephalic veins (17.4×10 −4 vs. 5.6×10 −4 cm 2 /mmHg, P<0.0001). Conclusions:The proposed non-invasive protocol proved feasible, effective and adequate for daily clinical practice, allowing for the estimation of patient-specific compliance and distensibility of peripheral arteries and veins. If further extended, it may contribute to the fabrication of biohybrid arterio-venous grafts, paving the way towards patient-tailored solutions for vascular access.

Aluminum Nitride Piezoelectric Micromachined Ultrasound Transducer Arrays for Non-Invasive Monitoring of Radial Artery Stiffness

“…In the latest research on arm arteries [ 27 ], the cross-sectional distensibility calculation methods are twice as small as those of our model in terms of mathematical expression; the measured data show good consistency with our measurement result (21.5%/100 mmHg vs. 4.03 × 10 −3 mmHg −1 ). The cross-sectional compliance calculation method is close to our model in terms of mathematical expression; the measured data also show good consistency with our measurement result (1.3 × 10 −4 cm 2 /mmHg vs. 1.87 × 10 −2 mm 2 /mmHg).…”

Sutureless vascular anastomotic approaches and their potential impacts

“…This promotes higher elasticity that prevents rupture in high pressured arterial vascular system. Increased elasticity and a thicker media lead to decreased compliance [ 18 ]. This inherent vascular nature of arteries makes them difficult to evert over the device.…”

“…This structural composition confers arteries with greater elasticity, a crucial adaptation that protects them from rupturing under the high pressure conditions characteristic of the arterial vascular system. However, this increased elasticity coupled with a thicker media layer results in decreased compliance, presenting challenges for the effectiveness of existing sutureless anastomotic devices in arterial surgery [ 18 ].…”