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Bilateral photoplethysmography for arterial steal detection in arteriovenous fistula using a fractional-order decision-making quantizer

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Abstract

As inflow and outflow stenoses worsen, both flow resistance and pressure increase in the stenotic vascular access. During dialysis, when blood flow decreases, it may retrograde from the peripheral artery through the palmar arch to the arterial anastomosis site. Arterial steal syndrome (ASS) causes distal hypoperfusion, resulting in hand ischemia or extremity pain and edema. Hence, this study proposes the bilateral photoplethysmography (PPG) for ASS detection in arteriovenous fistulas. The decision-making quantizer utilizes the fractional-order feature extraction method and a non-cooperative game (NCG) framework to evaluate the ASS risk level. Bilateral asynchronous PPG signals have significant differences in the rise time and amplitude in relation to the degree of stenosis. The fractional-order self-synchronization error formulation is a feature extraction method used to quantify bilateral differences in blood flow changes between the dexter and sinister PPG signals. The NCG model as a method of decision-making is then employed to evaluate the ASS risk level. Using an acoustic Doppler measurement, the resistive (Res) index is also used to evaluate the vascular access stenosis at the arterial anastomosis site. In contrast with alternative methods including the high-sensitivity C-reactive protein level or Res index, our experimental results indicate that the proposed decision-making quantizer is more efficient in preventing ASS during hemodialysis treatment.

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Acknowledgments

This work is supported in part by the Ministry of Science and Technology, Taiwan, under contract number: MOST 103-2221-E-244-001, duration: August 1 2014–July 31 2015. The Institutional Review Board (IRB) of the Kaohsiung Veterans General Hospital, Tainan Branch, under contract number: VGHKS13-CT12-11.

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Authors and Affiliations

  1. National Synchrotron Radiation Research Center, Hsinchu Science Park, Hsinchu, Taiwan

    Jian-Xing Wu & Guan-Chun Chen

  2. Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan City, 71051, Taiwan

    Ming-Jui Wu

  3. Department of Electrical Engineering, Kao-Yuan University, Kaohsiung City, 82151, Taiwan

    Chia-Hung Lin

  4. Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 70101, Taiwan

    Tainsong Chen

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  1. Jian-Xing Wu
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  2. Guan-Chun Chen
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  3. Ming-Jui Wu
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Correspondence to Ming-Jui Wu or Chia-Hung Lin.

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Wu, JX., Chen, GC., Wu, MJ. et al. Bilateral photoplethysmography for arterial steal detection in arteriovenous fistula using a fractional-order decision-making quantizer. Med Biol Eng Comput 55, 257–270 (2017). https://doi.org/10.1007/s11517-016-1503-z

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