Dataset Information

The Role of Artificial Intelligence in the Prediction of Functional Maturation of Arteriovenous Fistula.

ABSTRACT: Objective: The aim of this study is to examine the application of virtual artificial intelligence (AI) in the prediction of functional maturation (FM) and pattern recognition of factors in autogenous radiocephalic arteriovenous fistula (RCAVF) formation. Materials and Methods: A prospective database of 266 individuals over a four-year period with n=10 variables were used to train, validate and test an artificial neural network (ANN). The ANN was constructed to create a predictive model and evaluate the impact of variables on the endpoint of FM. Results: The overall accuracy of the training, validation, testing and all data on each output matrix at detecting FM was 86.4%, 82.5%, 77.5% and 84.5%, respectively. The results corresponded with their area under the curve for each output matrix at best sensitivity and at 1-specificity with the log-rank test p<0.01. ANN classification identified age, artery and vein diameter to influence FM with an accuracy of (>89%). AI has the ability of predicting with a high grade of accuracy FM and recognising patterns that influence it. Conclusion: AI is a replicable tool that could remain up to date and flexible to ongoing deep learning with further data feed ensuring substantial enhancement in its accuracy. AI could serve as a clinical decision-making tool and its application in vascular access requires further evaluation.

SUBMITTER: Kordzadeh A

PROVIDER: S-EPMC6434352 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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The Role of Artificial Intelligence in the Prediction of Functional Maturation of Arteriovenous Fistula.

Kordzadeh Ali A Esfahlani Shabnam Sadeghi SS

Annals of vascular diseases 20190301 1

<b>Objective</b>: The aim of this study is to examine the application of virtual artificial intelligence (AI) in the prediction of functional maturation (FM) and pattern recognition of factors in autogenous radiocephalic arteriovenous fistula (RCAVF) formation. <b>Materials and Methods</b>: A prospective database of 266 individuals over a four-year period with n=10 variables were used to train, validate and test an artificial neural network (ANN). The ANN was constructed to create a predictive m ...[more]

PMID: 30931056

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Project description:BACKGROUND:The arteriovenous fistula (AVF) is central to haemodialysis treatment, but up to half of surgically created AVF fail to mature. Chronic kidney disease often leads to mineral metabolism disturbances that may interfere with AVF maturation through adverse vascular effects. This study tested associations between mineral metabolism markers and vein histology at AVF creation and unassisted and overall clinical AVF maturation. METHODS:Concentrations of fibroblast growth factor 23, parathyroid hormone, calcium, phosphate, and vitamin D metabolites: 1,25(OH)2D, 24,25(OH)2D, 25(OH)D, and bioavailable 25(OH)D were measured in pre-operative serum samples from 562 of 602 participants in the Haemodialysis Fistula Maturation Study, a multicentre, prospective cohort study of patients undergoing surgical creation of an autologous upper extremity AVF. Unassisted and overall AVF maturation were ascertained for 540 and 527 participants, respectively, within nine months of surgery or four weeks of dialysis initiation. Study personnel obtained vein segments adjacent to the portion of the vein used for anastomosis, which were processed, embedded, and stained for measurement of neointimal hyperplasia, calcification, and collagen deposition in the medial wall. RESULTS:Participants in this substudy were 71% male, 43% black, and had a mean age of 55 years. Failure to achieve AVF maturation without assistance occurred in 288 (53%) participants for whom this outcome was determined. In demographic and further adjusted models, mineral metabolism markers were not significantly associated with vein histology characteristics, unassisted AVF maturation failure, or overall maturation failure, other than a biologically unexplained association of higher 24,25(OH)2D with overall failure. This exception aside, associations were non-significant for continuous and categorical analyses and relevant subgroups. CONCLUSIONS:Serum concentrations of measured mineral metabolites were not substantially associated with major histological characteristics of veins in patients undergoing AVF creation surgery, or with AVF maturation failure, suggesting that efforts to improve AVF maturation rates should increase attention to other processes such as vein mechanics, anatomy, and cellular metabolism among end stage renal disease patients.

Project description:BackgroundPrevious studies have not described the relationship between reducing radial artery diameter as well as increasing age and functional maturation of the radio-cephalic arteriovenous fistula (RCAVF) and no data identify these as linear relationship. The objective of this study was to perform trend analysis to assess these aspects.MethodsOur retrospective cohort study enrolled and analyzed 353 follow-up cases that underwent first AVF creation. The artery and vein sizes were measured by ultrasound. We performed follow-up, a minimum of 3 months after surgery. Multivariable logistic regression analysis was used to identify independent risk factors inmaturation. Participant age was categorized into four groups (age ≤ 29, 30-49, 50-69, and 70-90 years). Radial artery diameter was categorized into four groups (≤ 1.9, >1.9 and ≤ 2.1, >2.1 and ≤ 2.4, >2.4 mm) according to median and interquartile ranges. We adjusted for confounders in four logistic models, and primary analyses were based on building ordered category models and tested P values for trends to estimate the relationship of radial artery diameter and each 20-year increase in age with risk of maturation.ResultsThe mature RCAVF group included 301 cases, and the immature group included 52 cases. Radial artery diameter, age, and diabetes were independent risk factors of maturation. Odds ratios (ORs) associated with maturation reduced with increasing age, while ORs increased with increasing radial artery diameter. P values for trends(<0.05) were observed in all four models. A reduction in radial artery diameter and higher age were significantly associated with a higher incidence of immaturity after adjusting the multivariate models. The risks of immaturation were increased by more than 1.54 fold for each 20-year increase and increased by more than 1.34 fold for the smaller radial artery diameter group.ConclusionOur findings suggest that a significantly higher immaturity risk of RCAVF was associated with increasing age and a reduction in radial artery diameter. Our study identified a linear exposure-response relationship of age and radial artery diameter with immaturity incident. A careful selection of patients will be helpful in improving AVF functional maturation.

Project description:IntroductionNon-maturation and post-maturation venous stenosis are the primary causes of failure within arteriovenous fistulae (AVFs). Although the exact mechanisms triggering failure remain unclear, abnormal hemodynamic profiles are thought to mediate vascular remodelling and can adversely impact on fistula patency.AimThe review aims to clarify the role of shear stress on outward remodelling during maturation and evaluate the evidence supporting theories related to the localisation and development of intimal hyperplasia within AVFs.MethodsA systematic review of studies comparing remodelling data with hemodynamic data obtained from computational fluid dynamics of AVFs during and after maturation was conducted.ResultsOutward remodelling occurred to reduce or normalise the level of shear stress over time in fistulae with a large radius of curvature (curved) whereas shear stress was found to augment over time in fistulae with a small radius of curvature (straight) coinciding with minimal to no increases in lumen area. Although this review highlighted that there is a growing body of evidence suggesting low and oscillating shear stress may stimulate the initiation and development of intimal medial thickening within AVFs. Further lines of evidence are needed to support the disturbed flow theory and outward remodelling findings before surgical configurations and treatment strategies are optimised to conform to them. This review highlighted that variation between the time of analysis, classification of IH, resolution of simulations, data processing techniques and omission of various shear stress metrics prevented forming pooling of data amongst studies.ConclusionStandardised measurements and data processing techniques are needed to comprehensively evaluate the relationship between shear stress and intimal medial thickening. Advances in image acquisition and flow quantifications coupled with the increasing prevalence of longitudinal studies commencing from fistula creation offer viable techniques and strategies to robustly evaluate the relationship between shear stress and remodelling during maturation and thereafter.

Dataset Information

The Role of Artificial Intelligence in the Prediction of Functional Maturation of Arteriovenous Fistula.

Publications

The Role of Artificial Intelligence in the Prediction of Functional Maturation of Arteriovenous Fistula.

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