Evaluation of blood access dysfunction based on a wavelet transform analysis of shunt murmurs

Abstract

We investigated shunt murmurs based on wavelet transform analysis as a new method for assessing vascular access function. In the present study, in patients with venous stenosis near an arteriovenous fistula (A-V fistula), a sensor was placed at different positions around the stenosis and shunt murmur signals obtained using a measurement system were subjected to time–frequency analysis based on wavelet transforms. The shunt murmurs obtained from the stenotic region closely represented some features of murmurs that are often referred to as “high-pitch” murmurs in the clinical setting. In contrast, shunt murmurs obtained about 5 cm downstream of the stenotic region closely represented some features of murmurs that are often referred to as “low-pitch” murmurs in the clinical setting. Furthermore, with the aim of extending the lifespan of arteriovenous grafts (A-V grafts) by detecting and treating stenotic lesions before the A-V graft becomes occluded, we evaluated the possibility of utilizing the present shunt murmur analysis for monitoring stenosis in such A-V grafts. When shunt murmurs from patients with A-V grafts were analyzed, the results suggested that the blood flow through the venous anastomosis of the graft was the most turbulent. This present method whereby blood flow in an A-V fistula is assessed based on the frequency distribution on a time–frequency plane by wavelet transform analysis is advantageous because findings are not markedly affected by sensor attachment. Furthermore, because the sensor is attached using an adhesive collar, measurements can be taken over a short period of time before each dialysis session.