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Titolo Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients
Autore Anna Caroli1,10, Simone Manini1,10, Luca Antiga2, Katia Passera1, Bogdan Ene-Iordache1, Stefano Rota3, Giuseppe Remuzzi3, Aron Bode4, Jaap Leermakers4, Frans N. van de Vosse5,6, Raymond Vanholder7, Marko Malovrh8, Jan Tordoir4 and Andrea Remuzzi1,9 on behalf of the ARCH project Consortium11 1Biomedical Engineering Department, IRCCS Mario Negri Institute for Pharmacological Research, Bergamo, Italy; 2OROBIX S.r.l, Bergamo, Italy; 3Unit of Nephrology and Dialysis, Ospedali Riuniti, Bergamo, Italy; 4Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; 5Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; 6Department of Biomedical Engineering, Maastricht University Medical Center, Maastricht, The Netherlands; 7Nephrology Department, Ghent University Hospital, Ghent, Belgium; 8University Medical Centre Ljubljana, Ljubljana, Slovenia and 9Department of Industrial Engineering, University of Bergamo, Bergamo, Italy
Referenza Kidney International 2013, doi:10.1038/ki.2013.188

Vascular access dysfunction is one of the main causes of morbidity and hospitalization in hemodialysis patients. This major clinical problem points out the need for prediction of hemodynamic changes induced by vascular access surgery. Here we reviewed the potential of a patient-specific computational vascular network model that includes vessel wall remodeling to predict blood flow change within 6 weeks after surgery for different arteriovenous fistula configurations. For model validation, we performed a multicenter, prospective clinical study to collect longitudinal data on arm vasculature before and after surgery. Sixty-three patients with newly created arteriovenous fistula were included in the validation data set and divided into four groups based on fistula configuration. Predicted brachial artery blood flow volumes 40 days after surgery had a significantly high correlation with measured values. Deviation of predicted from measured brachial artery blood flow averaged 3% with a root mean squared error of 19.5%, showing that the computational tool reliably predicted patient-specific blood flow increase resulting from vascular access surgery and subsequent vascular adaptation. This innovative approach may help the surgeon to plan the most appropriate fistula configuration to optimize access blood flow for hemodialysis, potentially reducing the incidence of vascular access dysfunctions and the need of patient hospitalization.

Data 03.02.2014
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