Analysis of Factors Influencing Accuracy of Volume Flow Measurement in Dialysis Access Fistulas Based on Duplex Ultrasound Simulation

• Published in: Vascular and endovascular surgery 2019-10, Vol.53 (7), p.529-535
• Main Authors: Zierler, R. Eugene, Leotta, Daniel F., Sansom, Kurt, Aliseda, Alberto, Anderson, Mark D., Sheehan, Florence H.
• Format: Article
• Language: English
• Subjects: Arteriovenous Shunt, Surgical; Blood Flow Velocity; Computer Simulation; Humans; Hydrodynamics; Manikins; Models, Cardiovascular; Observer Variation; Predictive Value of Tests; Regional Blood Flow; Renal Dialysis; Reproducibility of Results; Transducers; Ultrasonography, Doppler, Color - instrumentation; Upper Extremity - blood supply
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574419858811

Objective: We developed a duplex ultrasound simulator and used it to assess accuracy of volume flow measurements in dialysis access fistula (DAF) models. Methods: The simulator consists of a mannequin, computer, and mock transducer. Each case is built from a patient’s B-mode images that are used to create a 3-dimensional surface model of the DAF. Computational fluid dynamics is used to determine blood flow velocities based on model vessel geometry. The simulator displays real-time B-mode and color-flow images, and Doppler spectral waveforms are generated according to user-defined settings. Accuracy was assessed by scanning each case and measuring volume flow in the inflow artery and outflow vein for comparison with true volume flow values. Results: Four examiners made 96 volume flow measurements on four DAF models. Measured volume flow deviated from the true value by 35 ± 36%. Mean absolute deviation from true volume flow was lower for arteries than veins (22 ± 19%, N = 48 vs. 58 ± 33%, N = 48, p < 0.0001). This finding is attributed to eccentricity of outflow veins which resulted in underestimating true cross-sectional area. Regression analysis indicated that error in measuring cross-sectional area was a predictor of error in volume flow measurement (β = 0.948, p < 0.001). Volume flow error was reduced from 35 ± 36% to 9 ± 8% (p < 0.000001) by calculating vessel area as an ellipse. Conclusions: Duplex volume flow measurements are based on a circular vessel shape. DAF inflow arteries are circular, but outflow veins can be elliptical. Simulation-based analysis showed that error in measuring volume flow is mainly due to assumption of a circular vessel.