title: Preoperative computer simulation for planning of vascular access surgery in hemodialysis patients.
abstract: BACKGROUND
  The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis patients. Unfortunately, 20-40% of all constructed AVFs fail to mature (FTM), and are therefore not usable for hemodialysis. AVF maturation importantly depends on postoperative blood volume flow. Predicting patient-specific immediate postoperative flow could therefore support surgical planning. A computational model predicting blood volume flow is available, but the effect of blood flow predictions on the clinical endpoint of maturation (at least 500 mL/min blood volume flow, diameter of the venous cannulation segment ≥4 mm) remains undetermined.
  
  
  METHODS
  A multicenter randomized clinical trial will be conducted in which 372 patients will be randomized (1:1 allocation ratio) between conventional healthcare and computational model-aided decision making. All patients are extensively examined using duplex ultrasonography (DUS) during preoperative assessment (12 venous and 11 arterial diameter measurements; 3 arterial volume flow measurements). The computational model will predict patient-specific immediate postoperative blood volume flows based on this DUS examination. Using these predictions, the preferred AVF configuration is recommended for the individual patient (radiocephalic, brachiocephalic, or brachiobasilic). The primary endpoint is FTM rate at six weeks in both groups, secondary endpoints include AVF functionality and patency rates at 6 and 12 months postoperatively.
  
  
  BACKGROUND
  ClinicalTrials.gov (NCT02453412), and ToetsingOnline.nl (NL51610.068.14).
authors.affiliation: Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht - The Netherlands.|Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht - The Netherlands.
authors.forename: Niek
authors.initials: N
authors.lastname: Zonnebeld
authors.affiliation: Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht - The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Huberts
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht - The Netherlands.
authors.forename: Magda M
authors.initials: MM
authors.lastname: van Loon
authors.affiliation: Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht - The Netherlands.
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
authors.affiliation: Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht - The Netherlands.
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Tordoir
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002985:Clinical Protocols; D006801:Humans; D008955:Models, Cardiovascular; D009426:Netherlands; D066230:Patient-Specific Modeling; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012107:Research Design; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*