The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Saati, Ammar; Puffenberger, Debra; Kirksey, Levester; Fendrikova-Mahlay, Natalia

doi:10.21037/cdt-22-129

Cardiovasc Diagn Ther

2023

DOI: 10.21037/cdt-22-129

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The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Ammar Saati¹,

Debra Puffenberger²,

Levester Kirksey³

et al.

Abstract: The rise in prevalence of end stage renal disease (ESRD) and the impact on health care resulted in increasing focus on delivery of vascular access. Hemodialysis vascular access is the most common renal replacement therapy method. The vascular access types include arteriovenous fistula, arteriovenous graft, and tunneled central venous catheters. Vascular access function remains an important outcome measure with significant impact on morbidity and health care cost. The survival and quality of life of patients on… Show more

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Cited by 7 publications

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References 25 publications

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“…A paper by Li et al ( 7 ) provides an overview of the novel technique of endovascular arteriovenous fistula creation in selected patients with suitable vascular anatomy. Saati and colleagues ( 8 ) discuss the role of duplex ultrasound in noninvasive vascular access surveillance. In their paper, Gonzalez et al ( 9 ) focus on multimodality imaging of arteriovenous fistula and grafts in patients with end-stage renal disease.…”

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Endovascular and surgical interventions in the end-stage renal disease population

Partovi¹,

Kirksey²

2023

Cardiovasc Diagn Ther

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Patients with end-stage renal disease require renal replacement therapy, which is most frequently performed via hemodialysis.To perform hemodialysis, a dialysis catheter or arteriovenous fistula or graft is needed as a means of vascular access. Once this initial surgical vascular access has been created, access maintenance can be performed using endovascular techniques. This special series encompasses a comprehensive multidisciplinary overview of advancements in these endovascular and surgical interventions in the end-stage renal disease population. It also sheds light on evolving technologies, such as endovascular arteriovenous fistula creation and the current evidence for the use of drug-coated balloons in vascular access maintenance.In their paper, Walker and Gadegbeku (1) emphasize the urgency of addressing health disparities in the end-stage renal disease population based on national guidelines. Richarz and colleagues (2) describe the preoperative imaging workup for vascular access creation and propose the use of advanced modalities as problem-solving tools for specific clinical questions. The paper by Ruff et al. (3) addresses the medical and endovascular management of atherosclerotic disease in the end-stage renal disease population. Montelongo and colleagues (4) outline various surgical creation techniques for upper extremity vascular access, whereas Alnahhal, Williams, and Kirksey (5) focus on surgical creation of lower extremity vascular access in patients with supradiaphragmatic central venous occlusion. Alnahhal, Rowse, and Kirksey (6) address the best approach for obtaining vascular access in clinical challenging cases. A paper by Li et al. (7) provides an overview of the novel technique of endovascular arteriovenous fistula creation in selected patients with suitable vascular anatomy. Saati and colleagues (8) discuss the role of duplex ultrasound in noninvasive vascular access surveillance. In their paper, Gonzalez et al. (9) focus on multimodality imaging of arteriovenous fistula and grafts in patients with end-stage renal disease. DePietro and Trerotola discuss the role of plain balloon angioplasty (10) and drug-coated balloon angioplasty (11) for vascular access maintenance in the end-stage renal disease population. In his paper, McLennan (12) describes stenting approaches for dialysis access maintenance. Wu, Kalva, and Cui (13) describe thrombectomy techniques used for the endovascular treatment of thrombosed vascular access, as well as the potential complications of these methods. A paper by Sharma et al. (14) discusses the role of tunneled dialysis catheters in the initiation of hemodialysis, including an overview of atypical infradiaphragmatic access site options for catheter placement. Two articles in this series address the challenge of central venous stenotic and occlusive disease in patients with chronic kidney disease. First, a paper by Alnahhal, Rowse, and Kirksey (15) provides an overview of management options for central venous disease. Second, an article by Rashwan and colleagues (1...

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Endovascular and surgical interventions in the end-stage renal disease population

Partovi¹,

Kirksey²

2023

Cardiovasc Diagn Ther

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Automatic calculation method for stenosis ratio based on dialysis access ultrasound image segmentation

Shi,

Zhu,

Zhi

et al. 2024

Medical Physics

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BackgroundDialysis Access (DA) stenosis impacts hemodialysis efficiency and patient health, necessitating exams for early lesion detection. Ultrasound is widely used due to its non‐invasive, cost‐effective nature. Assessing all patients in large hemodialysis facilities strains resources and relies on operator expertise. Furthermore, it heavily relies on the experience and expertise of the operator. Therefore, it is essential to explore methods for the automatic analysis of DA ultrasound images to accurately calculate the stenosis ratios, thereby enhancing both diagnostic accuracy and treatment efficiency.PurposeThis study is aimed at employing image segmentation networks to conduct precise segmentation of the ultrasound images of DA lumens and automatically classify the types of stenosis. The segmentation outcomes are processed by means of morphological processing techniques for the automatic calculation of the DA stenosis ratio, thus enhancing the daily diagnostic efficiency of physicians and providing a substantial quantitative foundation for clinical decision‐making.MethodsFirstly, our study introduces a deep neural network‐based approach for vascular lumen segmentation and classification, termed Vessel Lumen Segmentation and Classification‐Net (VLSC‐Net), aimed at the precise segmentation of the DA lumen in ultrasound images. We conducted comparative analyses of our network against U‐Net, TransUNet, MultiResUnet, and ResUNet using metrics such as mean Intersection over Union (mIoU), Dice score, Accuracy, Hausdorff Distance (HD), and Average Symmetric Surface Distance (ASSD). A five‐fold cross‐validation was performed on a dataset comprising 1710 images for both comparison experiments and ablation studies; specifically, the training set included 1368 images while the test set contained 342 images. The significance of observed differences was assessed using the Mann‐Whitney U‐test. To prevent the increase in the chance of making a Type I error (false positive) that occurs when many simultaneous tests are being conducted, we used the Bonferroni correction to address the problem of multiple comparisons. Since we did four groups of comparisons, the significance level () is adjusted by dividing it by 4. Secondly, we utilized morphological processing alongside feature extraction techniques to accurately delineate the edges of the lumen. This facilitated precise measurements of critical stenosis segment parameters. Finally, we automatically calculated the Long‐axis Diameter Stenosis Ratio (LDSR) and Short‐axis Area Stenosis Ratio (SASR) utilizing methods from the European Carotid Surgery Trial based on parameters derived from these calculations.ResultsVLSC‐Net demonstrated superior performance compared with traditional segmentation methods, effectively handling image artifacts while maintaining a compact structure. The mIoU, Dice score, Accuracy, HD, and ASSD were 0.9563, 0.9777, 0.9976, 4.542, and 0.460, respectively, and showed significant differences from the results of U‐Net (p 0.0125). An evaluation involving 1710 images from 62 patients indicated that our method delivers high‐precision and reliable stenosis ratio and classification outcomes within an average processing time of 164 ms. Furthermore, the average errors for LDSR and SASR were found to be 1.4% and 7.8%, respectively.ConclusionsOur approach greatly enhances diagnostic efficiency for medical personnel, offering reliable and objective evidence for clinical assessment and decision‐making in DA stenosis treatment, thereby reducing the risk of complications associated with DA stenosis.

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Integrating vascular access surveillance with clinical monitoring for stenosis prediction

Wu,

Lin

2023

J Nephrol

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The role of hemodialysis access duplex ultrasound for evaluation of patency and access surveillance

Cited by 7 publications

References 25 publications

Endovascular and surgical interventions in the end-stage renal disease population

Endovascular and surgical interventions in the end-stage renal disease population

Automatic calculation method for stenosis ratio based on dialysis access ultrasound image segmentation

Integrating vascular access surveillance with clinical monitoring for stenosis prediction

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