Preliminary evaluation of a novel surface accelerometer (HAVSE) for dialysis access surveillance: An exploratory...

Area of Science:

• Vascular Surgery
• Biomedical Engineering
• Medical Device Technology

Background:

• Arteriovenous fistula (AVF) dysfunction is often caused by hemodynamically significant stenosis, leading to altered blood flow turbulence and detectable vibrations.
• The Hemodialysis Access Vibration and Sound Evaluation (HAVSE) device, a surface accelerometer, quantifies these mechanical signals to assess AVF health.

Purpose of the Study:

• To evaluate if the HAVSE device can detect physiologically coherent changes in AVF vibrational amplitude before and after angioplasty.
• To assess the utility of HAVSE in differentiating types of arteriovenous fistula stenosis.

Main Methods:

• Prospective enrollment of adult patients with dysfunctional AVFs undergoing angioplasty.
• Collection of HAVSE recordings immediately before and after intervention at specific anatomical locations.
• Analysis of vibrational amplitude changes using a dimensionless postoperative-to-preoperative ratio and statistical tests.

Main Results:

• In isolated perianastomotic stenosis, HAVSE showed a significant decrease in vibrational amplitude post-angioplasty (median ratio 0.55, p=0.03).
• Isolated outflow stenosis showed an increased amplitude post-intervention (median ratio 2.10), suggesting restored turbulence, though not statistically significant.
• HAVSE had limited discriminatory performance in multifocal or central venous stenosis and could not reliably distinguish stenotic from non-stenotic sites based on amplitude thresholds.

Conclusions:

• Surface vibration analysis with HAVSE reveals physiologically coherent patterns for isolated perianastomotic and outflow AVF stenoses.
• Further development and validation of HAVSE are needed, particularly in larger studies incorporating Doppler ultrasound and standardized protocols, for multifocal or central venous disease.
• The study supports HAVSE's potential as a non-invasive tool for monitoring AVF hemodynamics post-intervention.