Abstract: SA-OR43
Use of a Digital Stethoscope to Evaluate Arteriovenous Fistulae before and after Intervention
Session Information
- Dialysis Vascular Access: Research Advances
October 26, 2024 | Location: Room 8, Convention Center
Abstract Time: 05:30 PM - 05:40 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Shariff, Saad Mohammed, The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
- Haddad, Samuel, The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
- Lee, Sora, The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
- Kieu, Spencer, Eko Health, Emeryville, California, United States
- Mathew, George, Eko Health, Emeryville, California, United States
- Xi, Gang, The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
- Roy-Chaudhury, Prabir, The University of North Carolina at Chapel Hill Kidney Center, Chapel Hill, North Carolina, United States
Background
Arteriovenous fistula (AVF) maturation failure, defined as the inability of the AVF to support dialysis via two-needle cannulation, remains a common, costly, and deleterious problem among dialysis patients, with stenosis within the venous segment a common cause. Evaluation of AVF patency and flow currently relies on imaging techniques like doppler ultrasound and fistulagrams to assess AVF dysfunction, procedures that both generally occur outside of the dialysis unit. In an attempt to develop screening tools for vascular access dysfunction that could be used in the hemodialysis unit itself, we herein present before and after phonocardiogram recordings obtained from patients undergoing AVF angioplasty for AVF maturation failure.
Methods
By physical examination, we identified the site of the arteriovenous anastomosis. We used the Eko Littman® CORE Digital Stethoscope and Eko smartphone app to obtain phonocardiogram recordings from three sites associated with the AVF: distal venous (8cm distal to the anastomosis), proximal arterial (2cm proximal to the anastomosis), and distal arterial (2cm distal to the anastomosis). De-identified recordings were labeled by location and exported prior to analysis.
Results
We observed differences in both the amplitude and profile (Fig. 1) of phonocardiogram recordings taken at the same site before and after intervention (angioplasty).
Conclusion
1. We have demonstrated the technical feasibility of using a portable, user-friendly, digital stethoscope and smartphone app in the setting of AVF maturation failure. 2. Clear differences in both the amplitude and profile of AVF phonocardiograms suggest that the Eko device could be used to risk stratify patients at high risk of a failed angioplasty for AVF maturation. 3. The Eko phonocardiograms could be an effective, low-cost screening tool for angioplasty success or failure in the setting of AVF maturation failure in the hemodialysis unit itself.
Figure 1. Change in amplitude and profile observed following angioplasty.
Funding
- Commercial Support – Eko Health