{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:34:53Z","timestamp":1793219693539,"version":"4.5.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Division of Diabetes, Endocrinology, and Metabolic Diseases","award":["R01DK141016"],"award-info":[{"award-number":["R01DK141016"]}]},{"name":"NHLBI Division of Intramural Research","award":["R01HL166608"],"award-info":[{"award-number":["R01HL166608"]}],"id":[{"id":"https:\/\/ror.org\/023ny1p48","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NHLBI Division of Intramural Research","award":["T32HL125232"],"award-info":[{"award-number":["T32HL125232"]}],"id":[{"id":"https:\/\/ror.org\/023ny1p48","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Boston University Chobanian and Avedisian School of Medicine","award":["Fibrosis Affinity Research Collaborative"],"award-info":[{"award-number":["Fibrosis Affinity Research Collaborative"]}],"id":[{"id":"https:\/\/ror.org\/05qwgg493","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Division of Diabetes, Endocrinology, and Metabolic Diseases","award":["R01DK141016"],"award-info":[{"award-number":["R01DK141016"]}]},{"name":"NHLBI Division of Intramural Research","award":["R01HL166608"],"award-info":[{"award-number":["R01HL166608"]}],"id":[{"id":"https:\/\/ror.org\/023ny1p48","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NHLBI Division of Intramural Research","award":["T32HL125232"],"award-info":[{"award-number":["T32HL125232"]}],"id":[{"id":"https:\/\/ror.org\/023ny1p48","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Boston University Chobanian and Avedisian School of Medicine","award":["Fibrosis Affinity Research Collaborative"],"award-info":[{"award-number":["Fibrosis Affinity Research Collaborative"]}],"id":[{"id":"https:\/\/ror.org\/05qwgg493","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Angiography systematically underestimates lumen size in geometrically complex, highly vascular stenotic regions.<\/jats:p>\n <\/jats:list-item>\n \n Intravascular ultrasound maintains accurate, geometry-resilient measurements across stenotic lesions, closely matching computer-aided design ground truth even in lesions with >50% stenosis.<\/jats:p>\n <\/jats:list-item>\n \n Intravascular ultrasound is a more accurate tool for diagnosing and guiding intervention in arteriovenous vascular access dysfunction than angiography.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Conventional angiography remains the standard diagnostic modality for arteriovenous (AV) access dysfunction in hemodialysis patients, but its geometric accuracy is limited. Intravascular ultrasound (IVUS) offers superior lesion detection, yet its absolute measurement accuracy remains uncertain. Using three-dimensional\u2013printed vascular conduits as reference standards, we assessed the accuracy of IVUS versus angiography, hypothesizing that complex conduit geometry, quantified by Gaussian curvature, would exacerbate angiographic error.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Clinically relevant AV access geometries were modeled with computer-aided design (CAD) and fabricated using three-dimensional printing. Lumen diameters were measured by contrast angiography and IVUS and compared with CAD dimensions. Conduit geometry was characterized using finite element\u2013based Gaussian curvature mapping. Paired Student\n t<\/jats:italic>\n test, Tukey-Kramer correction for multiple testing, and linear mixed-effect modeling were performed to examine the influence of clustering of lesions within conduits.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n IVUS demonstrated significantly lower measurement error compared with angiography, especially in stenotic segments with >50% luminal narrowing, which persisted even after correction for multiple comparisons (\n P<\/jats:italic>\n < 0.05). These high-grade stenoses frequently coincided with regions of especially high positive or negative Gaussian curvature, reflecting complex conduit geometry. In such regions, angiography consistently underestimated lumen diameter, with error magnitude increasing in curved or tortuous lesions. IVUS measurements closely approximated CAD measurements, retaining accuracy even in severe stenoses. For mild stenoses (<50%) and aneurysmal dilatations, both modalities performed comparably.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Geometric complexity directly contributes to modality-specific error. Angiography systematically underestimates lumen dimensions in complex, stenotic regions, while IVUS detects them with higher fidelity and preserves accuracy. These findings establish IVUS as the more reliable modality for evaluating AV access dysfunction and support its integration into routine practice in guiding intervention for AV access stenosis.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001128","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T17:00:27Z","timestamp":1771002027000},"page":"1741-1749","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Intravascular Ultrasound Is More Accurate Than Angiography in Arteriovenous Vascular Access Lesions"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6134-4015","authenticated-orcid":false,"given":"James W.","family":"Decker","sequence":"first","affiliation":[{"name":"Renal Section, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6025-3515","authenticated-orcid":false,"given":"Dima","family":"BaniHani","sequence":"additional","affiliation":[{"name":"College of Engineering and Computing, University of South Carolina, Columbia, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3388-9814","authenticated-orcid":false,"given":"Curtis","family":"HonShideler","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Department of Radiology, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5560-2912","authenticated-orcid":false,"given":"Saran","family":"Lotfollahzadeh","sequence":"additional","affiliation":[{"name":"Renal Section, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1074-9763","authenticated-orcid":false,"given":"David Jasen","family":"Wu Wong","sequence":"additional","affiliation":[{"name":"Renal Section, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7231-4189","authenticated-orcid":false,"given":"Alik","family":"Farber","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University Chobanian and Avedisian School of Medicine Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5989-035X","authenticated-orcid":false,"given":"Jeffrey J.","family":"Siracuse","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University Chobanian and Avedisian School of Medicine Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najia","family":"Idrees","sequence":"additional","affiliation":[{"name":"Boston Veterans Administration Healthcare System, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9735-7473","authenticated-orcid":false,"given":"Laura M.","family":"Dember","sequence":"additional","affiliation":[{"name":"Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Division of Epidemiology, Department of Epidemiology, Biostatistics and Informatics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Bader","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Department of Radiology, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3426-4907","authenticated-orcid":false,"given":"Suvranu","family":"Ganguli","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Department of Radiology, Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5312-8644","authenticated-orcid":false,"given":"Vijaya B.","family":"Kolachalama","sequence":"additional","affiliation":[{"name":"Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston University, Boston, Massachusetts"},{"name":"Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6214-5887","authenticated-orcid":false,"given":"Tarek","family":"Shazly","sequence":"additional","affiliation":[{"name":"College of Engineering and Computing, University of South Carolina, Columbia, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6663-6058","authenticated-orcid":false,"given":"Vipul C.","family":"Chitalia","sequence":"additional","affiliation":[{"name":"Renal Section, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts"},{"name":"Boston Veterans Administration Healthcare System, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"issue":"4 suppl 1","key":"B1-20261028","doi-asserted-by":"crossref","first-page":"A8","DOI":"10.1053\/j.ajkd.2024.01.001","article-title":"US Renal Data System 2023 annual data report: epidemiology of kidney disease in the United States","volume":"83","author":"Johansen","year":"2024","journal-title":"Am J Kidney Dis."},{"issue":"6S1","key":"B2-20261028","doi-asserted-by":"crossref","first-page":"A8","DOI":"10.1053\/j.ajkd.2025.02.602","article-title":"US Renal Data System 2024 annual data report: epidemiology of kidney disease in the United States","volume":"85","author":"Johansen","year":"2025","journal-title":"Am J Kidney Dis."},{"issue":"2","key":"B3-20261028","doi-asserted-by":"crossref","first-page":"269","DOI":"10.2215\/CJN.05540614","article-title":"Provider visit frequency and vascular access interventions in hemodialysis","volume":"10","author":"Erickson","year":"2015","journal-title":"Clin J Am Soc Nephrol."},{"issue":"11","key":"B4-20261028","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1681\/ASN.2019030318","article-title":"Long-term outcomes of arteriovenous fistulas with unassisted versus assisted maturation: a retrospective national hemodialysis Cohort Study","volume":"30","author":"Lee","year":"2019","journal-title":"J Am Soc Nephrol."},{"issue":"1","key":"B5-20261028","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jvs.2016.02.033","article-title":"Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use","volume":"64","author":"Harms","year":"2016","journal-title":"J Vasc Surg."},{"issue":"11","key":"B6-20261028","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1681\/ASN.2019090952","article-title":"Fistula interventions: less is more","volume":"30","author":"Lok","year":"2019","journal-title":"J Am Soc Nephrol."},{"issue":"9","key":"B7-20261028","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1016\/j.ekir.2023.06.013","article-title":"Contrast venography versus intravenous ultrasound in hemodialysis arteriovenous access dysfunction","volume":"8","author":"Idrees","year":"2023","journal-title":"Kidney Int Rep."},{"issue":"1","key":"B8-20261028","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1038\/s41598-024-85066-9","article-title":"Fluid structure interaction analysis for rupture risk assessment in patients with middle cerebral artery aneurysms","volume":"15","author":"Nagy","year":"2025","journal-title":"Sci Rep."},{"issue":"2","key":"B9-20261028","doi-asserted-by":"crossref","first-page":"e1011815","DOI":"10.1371\/journal.pcbi.1011815","article-title":"The geometric evolution of aortic dissections: predicting surgical success using fluctuations in integrated Gaussian curvature","volume":"20","author":"Khabaz","year":"2024","journal-title":"PLoS Comput Biol."},{"issue":"9","key":"B10-20261028","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.1007\/s11517-015-1417-1","article-title":"Modeling hemodynamic forces in carotid artery based on local geometric features","volume":"54","author":"Chen","year":"2016","journal-title":"Med Biol Eng Comput."},{"issue":"5","key":"B12-20261028","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.jvs.2010.11.100","article-title":"Management of true aneurysms of hemodialysis access fistulas","volume":"53","author":"Pasklinsky","year":"2011","journal-title":"J Vasc Surg."},{"issue":"14","key":"B13-20261028","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1161\/01.CIR.102.14.1657","article-title":"Feasibility of a novel blood noise reduction algorithm to enhance reproducibility of ultra-high-frequency intravascular ultrasound images","volume":"102","author":"Hibi","year":"2000","journal-title":"Circulation."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T20:00:22Z","timestamp":1793217622000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001128"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":12,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000001128","relation":{},"ISSN":["2641-7650","2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"},{"value":"2641-7650","type":"print"}],"subject":[],"published":{"date-parts":[[2026,2,13]]},"assertion":[{"value":"2025-09-19","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}