Abstract: TH-PO267
Arteriovenous-Oscillometry to Assess Fistula Function
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Busch, Veit, Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany
- Streis, Joachim, Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany
- Mueller, Niklas, Klinikum der Universität München Medizinische Klinik und Poliklinik III, München, Bavaria, Germany
- Müller, Sandra, Technische Universitat Wien Institut fur Diskrete Mathematik und Geometrie, Wien, Wien, Austria
- Seibert, Felix S., Marienhospital Herne Medizinische Klinik I Innere Medizin, Herne, Nordrhein-Westfalen, Germany
- Felderhoff, Thomas, Fachhochschule Dortmund, Dortmund, Nordrhein-Westfalen, Germany
- Westhoff, Timm H., Marienhospital Herne Medizinische Klinik I Innere Medizin, Herne, Nordrhein-Westfalen, Germany
Background
We recently demonstrated that pulse wave analysis may be useful in functional fistula monitoring using tonometric measurement. We now aimed to evaluate if convenient oscillometric devices are applicable to detect flow below 500 ml/min.
Methods
We recorded pulse waves ambilaterally with the vicorder® device at the brachial artery in 53 patients with native fistula and analyzed them with the use of a specifically developed matlab® application. The key parameters consisted of normalized variables assessed by the mean slope in the time sections between the footpoint, the systolic maximum (T1), the diacrotic notch, the first diastolic inflection point and the end of diastole: Specifically in the second section (slope2) and the sum of all four sections (slope∑). We furthermore assessed the amplitude of uncallibrated relative volumetric change in the measuring cuffs of the vicorder® device during cardiac cycle (AMP). Flow was measured with the use of duplex sonography.
Results
There were marked differences in the wave contours of the fistula and non-fistula side (Figure 1). Medians (fistula/non-fistula) of slope2, slope∑ and AMP were -0.00150/-0.00322 [relative amplitude/ms, p < 0.001], 0.01094/0.01187 [relative amplitude/ms, p=0.006] and 1850/725 [relative volumetric change, p< 0.001] (Wilcoxon test of related samples). T1 was delayed at the fistula arm (204 ± 3.4 ms versus 162 ± 5.3 ms at the non-fistula arm, p<0.001). ROC-analyses of parameter values measured at the fistula arm to detect low flow fistula demonstrated AUCs (with CI) of 0.652 (0.437-0.866, p=0.167) for slope2, 0.732 (0.566-0.899, p=0.006) for slope∑ and 0.775 (0.56-0.991, p=0.012) for AMP (Figure 2).
Conclusion
Fistula functional monitoring with oscillometry is feasible and is a promising clinical application to detect a low flow fistula.
Clinical characteristics
| N | Age | BMI | Gender | Fore/upper arm fistula | Diabetes | Permanent AF | CHD | HFrEF |
| 53 (100%) | 66±2.2 [years] | 25.6±0.6 [kg/m2 ] | 2.53 [m/f] | 2.31 | 30 (56.6%) | 17 (32.1%) | 18 (34%) | 5 (9.4%) |
Exemplary pulse waves at the fistula and non-fistula arm of one patient before and after treatment of fistula-stenosis.