title: Clinical use of computational modeling for surgical planning of arteriovenous fistula for hemodialysis.
abstract: Autogenous arteriovenous fistula (AVF) is the best vascular access (VA) for hemodialysis, but its creation is still a critical procedure. Physical examination, vascular mapping and doppler ultrasound (DUS) evaluation are recommended for AVF planning, but they can not provide direct indication on AVF outcome. We recently developed and validated in a clinical trial a patient-specific computational model to predict pre-operatively the blood flow volume (BFV) in AVF for different surgical configuration on the basis of demographic, clinical and DUS data. In the present investigation we tested power of prediction and usability of the computational model in routine clinical setting.
  
  
  
  We developed a web-based system (AVF.SIM) that integrates the computational model in a single procedure, including data collection and transfer, simulation management and data storage. A usability test on observational data was designed to compare predicted vs. measured BFV and evaluate the acceptance of the system in the clinical setting. Six Italian nephrology units were involved in the evaluation for a 6-month period that included all incident dialysis patients with indication for AVF surgery.
  
  
  
  Out of the 74 patients, complete data from 60 patients were included in the final dataset. Predicted brachial BFV at 40 days after surgery showed a good correlation with measured values (in average 787 ± 306 vs. 751 ± 267 mL/min, R = 0.81, p < 0.001). For distal AVFs the mean difference (±SD) between predicted vs. measured BFV was -2.0 ± 20.9%, with 50% of predicted values in the range of 86-121% of measured BFV. Feedbacks provided by clinicians indicate that AVF.SIM is easy to use and well accepted in clinical routine, with limited additional workload.
  
  
  
  Clinical use of computational modeling for AVF surgical planning can help the surgeon to select the best surgical strategy, reducing AVF early failures and complications. This approach allows individualization of VA care, with the aim to reduce the costs associated with VA dysfunction, and to improve AVF clinical outcome.
authors.affiliation: Department of Biomedical Engineering, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Bozzetto
authors.affiliation: Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rota
authors.affiliation: Unit of Nephrology and Dialysis, Ente Ecclesiastico "F. Miulli", Acquaviva delle Fonti, BA, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Vigo
authors.affiliation: Unit of Nephrology and Dialysis, Ente Ecclesiastico "F. Miulli", Acquaviva delle Fonti, BA, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Casucci
authors.affiliation: Unit of Nephrology and Dialysis, Ente Ecclesiastico "F. Miulli", Acquaviva delle Fonti, BA, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Lomonte
authors.affiliation: Unit of Nephrology and Dialysis, A.O. Cannizzaro, Catania, Italy.
authors.forename: Walter
authors.initials: W
authors.lastname: Morale
authors.affiliation: Unit of Nephrology and Dialysis, Ospedale Annunziata, Cosenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Senatore
authors.affiliation: Department of Urology and Nephrology, Catholic University, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tazza
authors.affiliation: Unit of Nephrology and Dialysis, Ospedale S. Spirito, Pescara, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Lodi
authors.affiliation: Department of Biomedical Engineering, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy.|Unit of Nephrology and Dialysis, ASST Papa Giovanni XXIII, Bergamo, Italy.|Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Remuzzi
authors.affiliation: Department of Biomedical Engineering, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Bergamo, Italy. andrea.remuzzi@marionegri.it.|Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy. andrea.remuzzi@marionegri.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Remuzzi
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011183:Postoperative Complications / Q000517:prevention & control*; D006435:Renal Dialysis / Q000379:methods*
keywords: Arteriovenous fistula; Computational modeling; Hemodialysis vascular access; Surgical planning