| Description |
Hemodialysis vascular access, the interface between a dialysis patient and a dialysis machine, is quite literally the lifeblood of a patient's health. Vascular access dysfunction is the leading cause of hospitalization in hemodialysis patients. The occlusive growth of neointimal hyperplasia (NH) in expanded polytetrafluoroethylene (ePTFE) ringed grafts is the primary cause of failure. To further develop a proposed thermal ultrasound treatment to reduce or prevent NH in arteriovenous vascular grafts, the acoustic properties of ePTFE were studied in water and alcohol solutions. Previous reports of ePTFE acoustic properties are critiqued. It was found that the acoustic transmission and attenuation through ePTFE, and therefore the potential for an ultrasound-based therapy for NH, are heavily dependent on the medium in which the graft is immersed, suggesting that the acoustic properties of implanted grafts will change as grafts mature in vivo. The acoustic impedance and attenuation of water-soaked ePTFE were 0.478 ± 1.43 × 10-2 MRayl and 1.78 ± 0.111 Np/cm·MHz, respectively, while the acoustic impedance and attenuation of ePTFE in alcohol were 1.49 ± 0.149 MRayl and 0.77 ± 1.1 × 10-2 Np/cm·MHz, respectively. The use of focused ultrasound to heat implanted ringed ePTFE grafts was numerically modeled from 1.35- and 1.443-MHz transducers for in vitro geometries. Power deposition and heating, in turn, differed by an order of magnitude between various graft acoustic properties. Graft rings were predicted to be substantial absorbing and iv scattering features. In vitro phantom models were constructed: one with and one without thermocouples. At 1 W of acoustic power, the maximum temperature rise was 8˚ C. The thermocouple model containing a water-soaked graft did not experience heating in the far graft wall. The MRTI model confirmed that the graft rings are an absorbing/scattering feature. Heating was not prevented in the presence of water flow through the graft. Water was not heated significantly. Overall, results suggest ultrasound exposure can be used to generate temperature rises corresponding with the potential prevention or inhibition of NH in ringed ePTFE vascular grafts. A hybrid therapeutic/diagnostic transducer design with a therapeutic semi-annular array surrounding a diagnostic linear array is presented. Compared to a solid transducer of the same dimensions, there were only marginal aberrations in the focal plane. Numerical optimization of the element drive configuration indicated that the least distorted focal plane was produced by uniform phase and magnitude at each element. |
