Application of Freehand 3D Ultrasound Guidance in Percutaneous Transluminal Angioplasty for Autogenous Arteriovenous Fistula Stenosis
DOI:
https://doi.org/10.59958/hsf.7023Keywords:
freehand 3D ultrasound imaging, Doppler ultrasound, autogenous arteriovenous fistula, percutaneous transluminal angioplasty, hemodialysis, stenosis, patency rateAbstract
Objective: Using freehand three dimensional (3D) ultrasound imaging to evaluate arteriovenous fistula stenosis. Comparing the value of freehand 3D ultrasound and Doppler ultrasound in the application of percutaneous transluminal angioplasty (PTA) treatment for stenosis of an arteriovenous fistula. Methods: A retrospective analysis was conducted on 34 patients with arteriovenous fistula (AVF) stenosis who were treated at the 903RD Hospital of PLA and the Kidney Center of Zhejiang Provincial People's Hospital from August 2021 to August 2022. Based on the different types of surgical assistance, the patients were divided into two groups: the Doppler ultrasound group (Group A, n = 17) and the freehand 3D ultrasound imaging group (Group B, n = 17). Freehand 3D ultrasound and Doppler ultrasound were used to assess the narrowing of arteriovenous fistulas, and images and relevant data were collected before and after the PTA procedure. The differences in the time of puncture and sheath placement, guidewire insertion time, the duration of the procedure, complications, and methods to measure stenosis were compared between the two groups of patients, as well as the technical success rate, the initial patency rate, and the primary patency rates at 1, 3, 6 and 9 months post-surgery. This study discusses the clinical efficacy of using these two types of ultrasound to assist in the PTA treatment of arteriovenous fistula stenosis. Results: The differences in baseline demographics between the conventional ultrasound group (Group A) and the 3D ultrasound group (Group B) were not statistically significant (p > 0.05). The intraoperative guidewire insertion time (4.647 ± 1.347 min vs. 2.824 ± 0.326 min) and the operating times (75.941 ± 7.557 min vs. 59.824 ± 8.175 min) between the two groups were statistically significant (t = 2.788, 3.069, p < 0.01). The technical success rates for the two groups were 94.1% vs. 100%, not statistically significant (t = 1.03, p = 0.31). The first-time patency rates were 88.2% vs. 94.1%, with no statistically significant difference (t = 0.366, p = 0.545). No complications occurred in Group A, while one case of hematoma occurred postoperatively in Group B, with an incidence of 5.9% (1/17), which was not statistically significant (t = 1.03, p > 0.05). Comparing the primary patency rates at 1, 3, 6 and 9 months post-surgery between Groups A and B, there were no statistically significant differences (p > 0.05). However, the patency rates at different time points for Group B were consistently higher than Group A (94.1%, 82.4%, 82.4%, 82.4% vs. 88.2%, 82.4%, 76.5%, 76.5%). Conclusion: Freehand 3D ultrasound imaging can provide more intuitive, high-resolution, and high-definition three-dimensional images, clearly defining the lesion site and vascular structures. Its accuracy in assessing complications of arteriovenous fistulas is similar to that with conventional ultrasound. When used as an adjunct to PTA treatment, its efficacy is equivalent. It can significantly reduce guidewire insertion time and operation time, decrease postoperative recovery time, and alleviate the patients' concerns regarding surgical risks. It can be considered a new method for diagnosing, treating, and patients with AVF stenosis.
References
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. American Journal of Kidney Diseases. 2020; 75: S1–S164.
Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. American Journal of Kidney Diseases. 2014; 63: 464–478.
Pantelias K, Grapsa E. Vascular access today. World Journal of Nephrology. 2012; 1: 69–78.
Miller PE, Tolwani A, Luscy CP, Deierhoi MH, Bailey R, Redden DT, et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney International. 1999; 56: 275–280.
Woo K, Fuld R, Grandinetti A, Lawson J, Litchfield T, Ohan M, et al. Patient-reported outcomes in hemodialysis vascular access: A call to action. The Journal of Vascular Access. 2022; 23: 973–980.
Wang Y, Krishnamoorthy M, Banerjee R, Zhang J, Rudich S, Holland C, et al. Venous stenosis in a pig arteriovenous fistula model--anatomy, mechanisms and cellular phenotypes. Nephrology, Dialysis, Transplantation. 2008; 23: 525–533.
Brahmbhatt A, Remuzzi A, Franzoni M, Misra S. The molecular mechanisms of hemodialysis vascular access failure. Kidney International. 2016; 89: 303–316.
Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al. Editor's Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2018; 55: 757–818.
Mozaffari MH, Lee WS. Freehand 3-D Ultrasound Imaging: A Systematic Review. Ultrasound in Medicine & Biology. 2017; 43: 2099–2124.
Bojakowski K, Góra R, Szewczyk D, Andziak P. Ultrasound-guided angioplasty of dialysis fistula - technique description. Polish Journal of Radiology. 2013; 78: 56–61.
Cho S, Lee YJ, Kim SR. Clinical experience with ultrasound guided angioplasty for vascular access. Kidney Research and Clinical Practice. 2017; 36: 79–85.
Wakabayashi M, Hanada S, Nakano H, Wakabayashi T. Ultrasound-guided endovascular treatment for vascular access malfunction: results in 4896 cases. The Journal of Vascular Access. 2013; 14: 225–230.
Granata A, Maccarrone R, Di Lullo L, Morale W, Battaglia GG, Di Nicolò P, et al. Feasibility of routine ultrasound-guided percutaneous transluminal angioplasty in the treatment of native arteriovenous fistula dysfunction. The Journal of Vascular Access. 2021; 22: 739–743.
BAUM G, GREENWOOD I. Orbital lesion localization by three dimensional ultrasonography. New York State Journal of Medicine. 1961; 61: 4149–4157.
Huang Q, Zeng Z. A Review on Real-Time 3D Ultrasound Imaging Technology. BioMed Research International. 2017; 2017: 6027029.
Marcadent S, Heches J, Favre J, Desseauve D, Thiran JP. 3-D Freehand Ultrasound Calibration Using a Tissue-Mimicking Phantom With Parallel Wires. Ultrasound in Medicine & Biology. 2023; 49: 165–177.
Artas H, Okcesiz I. Three-dimensional ultrasonographic evaluation of carotid artery plaque surface irregularity. Archives of Medical Science. 2019; 16: 58–65.
Liao CC, Chen PY, Lin SK. Normal norms of carotid vessel wall volume in Taiwanese adults as measured using three-dimensional ultrasound. Acta Neurologica Taiwanica. 2023; 32: 16–24.
Chiu B, Shamdasani V, Entrekin R, Yuan C, Kerwin WS. Characterization of carotid plaques on 3-dimensional ultrasound imaging by registration with multicontrast magnetic resonance imaging. Journal of Ultrasound in Medicine. 2012; 31: 1567–1580.
Igase K, Kumon Y, Matsubara I, Arai M, Goishi J, Watanabe H, et al. Utility of 3-dimensional ultrasound imaging to evaluate carotid artery stenosis: comparison with magnetic resonance angiography. Journal of Stroke and Cerebrovascular Diseases. 2015; 24: 148–153.
Rogers S, Simm K, McCollum C, Kiyegga S, Haque A, Lea S, et al. Arteriovenous Fistula Surveillance Using Tomographic 3D Ultrasound. European Journal of Vascular and Endovascular Surgery. 2021; 62: 82–88.
Rogers S, Carreira J, Phairv A, Ghosh J, Bowling F, McCollum C. Evaluating Potential Autologous Bypass Grafts with Tomographic Three-Dimensional Ultrasound Compared with Standard Color Duplex. Annals of Vascular Surgery. 2022; 85: 167–174.
Buia A, Stockhausen F, Filmann N, Hanisch E. 3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of standardised black box training in laparoscopic surgery. Langenbeck's Archives of Surgery. 2017; 402: 167–171.
