Preoperative computer simulation for planning of vascular access surgery in hemodialysis patients

Niek Zonnebeld*, Wouter Huberts, Magda M. van Loon, Tammo Delhaas, Jan H. M. Tordoir

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis patients. Unfortunately, 20-40% of all constructed AVFs fail to mature (FTM), and are therefore not usable for hemodialysis. AVF maturation importantly depends on postoperative blood volume flow. Predicting patient-specific immediate postoperative flow could therefore support surgical planning. A computational model predicting blood volume flow is available, but the effect of blood flow predictions on the clinical endpoint of maturation (at least 500 mL/min blood volume flow, diameter of the venous cannulation segment >= 4 mm) remains undetermined.

Methods: A multicenter randomized clinical trial will be conducted in which 372 patients will be randomized (1:1 allocation ratio) between conventional healthcare and computational model-aided decision making. All patients are extensively examined using duplex ultrasonography (DUS) during preoperative assessment (12 venous and 11 arterial diameter measurements; 3 arterial volume flow measurements). The computational model will predict patient-specific immediate postoperative blood volume flows based on this DUS examination. Using these predictions, the preferred AVF configuration is recommended for the individual patient (radiocephalic, brachiocephalic, or brachiobasilic). The primary endpoint is FTM rate at six weeks in both groups, secondary endpoints include AVF functionality and patency rates at 6 and 12 months postoperatively.

Original languageEnglish
Pages (from-to)S118-S124
Number of pages7
JournalJournal of vascular access
Volume18
Issue number1
DOIs
Publication statusPublished - Mar 2017

Keywords

  • Arteriovenous fistula
  • Computational modelling
  • Failure to mature (FTM)
  • Maturation
  • Vascular access
  • PULSE-WAVE PROPAGATION
  • ARTERIOVENOUS-FISTULAS
  • SENSITIVITY-ANALYSIS
  • MODEL PARAMETERS
  • IDENTIFICATION
  • MATURATION
  • OUTCOMES
  • FAILURE
  • PATENCY
  • PART

Fingerprint

Dive into the research topics of 'Preoperative computer simulation for planning of vascular access surgery in hemodialysis patients'. Together they form a unique fingerprint.

Cite this