# Role of intravascular ultrasound in Central Venous Stenosis in ESRD patients

> **NIH NIH R21** · BOSTON MEDICAL CENTER · 2020 · $238,966

## Abstract

Project Summary
Central venous stenosis (CVS) involves any one of the central veins such as subclavian, brachiocephalic
and internal jugular veins, and superior vena cava in the patients with end stage renal disease. CVS is an
important clinical problem as it currently affects 15-50% of ESRD patients and is thought to be responsible
for 21-50% cases of vascular access malfunction. Both the diagnostic and the therapeutic landscapes of
CVS represent areas of unmet need. Contrast venography is the standard-of-care for diagnosing CVS.
However, this approach has several limitations including inaccurate determination of the extent of stenosis.
In other clinical settings, the management of venous stenosis is increasingly influenced by the morphology
of stenotic lesions. But venography fails to provide this information. While the endovascular interventions
for CVS have encouraging short-term success rates, its long-term unassisted patency rates remain dismal.
These interventions even increase the progression of the stenotic lesions in some cases. Currently, there
are no methods for predicting which lesions are likely to improve or undergo accelerated progression from
the intervention, and this represents a major knowledge gap in this area.
 An overarching objective of this project is to gain a deeper understanding of the types of lesions
constituting CVS and their responses to the endovascular interventional therapies. This information will
guide the development of a strategy to customize the intervention for those lesions that is likely to yield
maximum therapeutic benefit. This pilot proposal represents an initial step towards this objective and
explores the use of Intravascular ultrasound (IVUS) to overcome limitations of venography. IVUS uses
radiofrequency ultrasound backscatter data to detect stenotic venous lesions. Image analysis will provide
the morphological composition of the lesions. Aim 1 of this pilot study will compare venography to IVUS in
detecting CVS to obtain a preliminary sensitivity of IVUS. Aim 2 will classify and map the morphology of
stenotic lesions. The results from this pilot study will guide sufficiently powered future studies to
demonstrate the superiority of IVUS compared to venography in diagnosing CVS. It will also seed
interventional studies where the response to angioplasty will be compared based on the morphology of
CVS lesions.

## Key facts

- **NIH application ID:** 9896231
- **Project number:** 1R21DK119740-01A1
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Vipul C Chitalia
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $238,966
- **Award type:** 1
- **Project period:** 2020-07-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9896231

## Citation

> US National Institutes of Health, RePORTER application 9896231, Role of intravascular ultrasound in Central Venous Stenosis in ESRD patients (1R21DK119740-01A1). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9896231. Licensed CC0.

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