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Ultrasound Vector Flow Imaging – could be a new tool in evaluation of arteriovenous fistulas for hemodialysis?

Abstract

Introduction

We report the use of a new ultrasound technique to evaluate the axial and lateral components of a complex flow in the arteriovenous fistula (AVF). Vector Flow Imaging (VFI) allows to identify different components of the flow in every direction, even orthogonal to the flow streamline, represented by many single vectors. VFI could help to identify flow alterations in AVF, probably responsible for its malfunction.

Methods

From February to June 2016, 14 consecutive patients with upper-limb AVF were examined with a Resona 7 (Mindray, Shenzhen, China) ultrasound scanner equipped with VFI. An analysis of mean velocity, angular direction and mean number of vectors impacting the vessel wall was carried out. We also identified main flow patterns present in the arterial side, into the venous aneurysm and in correspondence of significant stenosis.

Results

A disturbed flow with the presence of vectors directed against the vessel walls was found in 9/14 patients (64.28%): in correspondence of the iuxta-anastomotic venous side (4/9; 44.4%), into the venous aneurysmal tracts (3/9; 33.3%) and in concomitance of stenosis (2/9; 22.2%). The mean velocity of the vectors was around 20-25 cm/s, except in presence of stenosis, where the velocities were much higher (45-50 cm/s). The vectors directed against the vessel walls presented high angle attack (from 45° to 90°, with a median angular deviation 65°).

Conclusions

VFI was confirmed to be an innovative and intuitive imaging technology to study the flow complexity in the arteriovenous fistulas.

J Vasc Access 2017; 18(4): 284 - 289

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/jva.5000721

Authors

Ilaria Fiorina, Maria Vittoria Raciti, Alfredo Goddi, Vito Cantisani, Chandra Bortolotto, Shane Chu, Fabrizio Calliada

Article History

Disclosures

Financial support: No grants or funding have been received for this study.
Conflict of interest: Ilaria Fiorina received congress travel cost reimbursement by Shenzen Mindray Bio-Medical Electronic Co. Fabrizio Calliada was consultant for Hitachi Medical System Europe, Toshiba Medical System Europe and Shenzen Mindray Bio-Medical Electronics Co. Alfredo Goddi was consultant for Esaote medical diagnostic systems, Shenzen Mindray Bio-Medical Electronic Co. and Supersonic Imagine. Vito Cantisani was lecturer for Bracco Imaging, Samsung Medison and Hitachi Medical System Europe.

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Authors

Affiliations

  • Radiology Department, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia - Italy
  • Centro Medico SME-Diagnostica per Immagini, Varese - Italy
  • Radiology Department, Policlinico Umberto I, Università la Sapienza, Roma - Italy
  • Shenzen Mindray Bio-Medical Electronics Co., Shenzen - China

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