In dialysis treatment, the radio-cephalic arteriovenous fistula (RCAVF) is a commonly used fistula, yet its low maturation rate remains a challenge. To enhance surgical outcomes, the relationship between stenosis-prone locations and RCAVF anastomosis angle is studied during maturation by developing two sets of RCAVF models for early (non-mature) and mature RCAVFs at five anastomosis angles. The impact of hemodynamics and wall shear stress (WSS) is examined to determine optimal anastomotic angles. Results indicate that acute angles produce more physiological WSS distributions and fewer disturbed regions, with early stenosis-prone regions located near the anastomosis that shift to the bending venous segment during remodeling. A pilot study comparing clinical and numerical results is conducted for validation.
References
[1]
Atkins, R.C. (2005) The Epidemiology of Chronic Kidney Disease. Kidney International, 67, S14-S18. https://doi.org/10.1111/j.1523-1755.2005.09403.x
[2]
Lok, C.E. and Davidson, I. (2012) Optimal Choice of Dialysis Access for Chronic Kidney Disease Patients: Developing a Life Plan for Dialysis Access. Seminars in Nephrology, 32, 530-537. https://doi.org/10.1016/j.semnephrol.2012.10.003
[3]
Schmidli, J., Widmer, M.K., Basile, C., Donato, G., Gallieni, M., Gibbons, C.P., Haage, P., Hamilton, G., Hedin, U., Kamper, L., et al. (2018) Editor’s Choice—Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery, 55, 757-818. https://doi.org/10.1016/j.ejvs.2018.02.001
[4]
Remuzzi, A. and Bozzetto, M. (2017) Biological and Physical Factors Involved in the Maturation of Arteriovenous Fistula for Hemodialysis. Cardiovascular Engineering and Technology, 8, 273-279. https://doi.org/10.1007/s13239-017-0323-0
[5]
Wong, C.-Y., de Vries, M.R., Wang, Y., van der Vorst, J.R., Vahrmeijer, A.L., van Zonneveld, A.J., Roy-Chaudhury, P., Rabelink, T.J., Quax, P.H.A. and Rotmans, J.I. (2014) Vascular Remodeling and Intimal Hyperplasia in a Novel Murine Model of Arteriovenous Fistula Failure. Journal of Vascular Surgery, 59, 192-201.e1. https://doi.org/10.1016/j.jvs.2013.02.242
[6]
Wootton, D.M. and Ku, D.N. (1999) Fluid Mechanics of Vascular Systems, Diseases, and Thrombosis. Annual Review of Biomedical Engineering, 1, 299-329. https://doi.org/10.1146/annurev.bioeng.1.1.299
[7]
Yang, Y., Schiava, N.D., Kulisa, P., Hajem, M.E., Bou-Saïd, B., Simoëns, S. and Lermusiaux, P. (2021) Optimization of Maturation of Radio-Cephalic Arteriovenous Fistula Using a Model Relating Energy Loss Rate and Vascular Geometric Parameters. Journal of Biomedical Science and Engineering, 14, 271-287. https://doi.org/10.4236/jbise.2021.146023
[8]
Sivanesan, S. (1999) Sites of Stenosis in AV Fistulae for Haemodialysis Access. Nephrology Dialysis Transplantation, 14, 118-120. https://doi.org/10.1093/ndt/14.1.118
[9]
Waite, L. and Fine, J.M. (2017) Applied Biofluid Mechanics. 2nd Edition, McGraw Hill Education, New York.
[10]
Morales, H.G., Larrabide, I., Geers, A.J., Aguilar, M.L. and Frangi, A.F. (2013) Newtonian and Non-Newtonian Blood Flow in Coiled Cerebral Aneurysms. Journal of Biomechanics, 46, 2158-2164. https://doi.org/10.1016/j.jbiomech.2013.06.034
[11]
Kim, S.-W. and Benson, T.J. (1992) Comparison of the SMAC, PISO and Iterative Time-Advancing Schemes for Unsteady Flows. Computers & Fluids, 21, 435-454. https://doi.org/10.1016/0045-7930(92)90048-Z
[12]
Ochsner, A., Colp, R. and Burch, G.E. (1951) Normal Blood Pressure in the Superficial Venous System of Man at Rest in the Supine Position. Circulation, 3, 674-680. https://doi.org/10.1161/01.CIR.3.5.674
[13]
Wilson, K.E., Tat, J. and Keir, P.J. (2017) Effects of Wrist Posture and Fingertip Force on Median Nerve Blood Flow Velocity. BioMed Research International, 2017, e7156489. https://doi.org/10.1155/2017/7156489
[14]
Beniwal, S., Bhargava, K. and Kausik, S.K. (2014) Size of Distal Radial and Distal Ulnar Arteries in Adults of Southern Rajasthan and Their Implications for Percutaneous Coronary Interventions. Indian Heart Journal, 66, 506-509. https://doi.org/10.1016/j.ihj.2014.08.010
[15]
Willemet, M., Chowienczyk, P. and Alastruey, J. (2015) A Database of Virtual Healthy Subjects to Assess the Accuracy of Foot-to-Foot Pulse Wave Velocities for Estimation of Aortic Stiffness. American Journal of Physiology—Heart and Circulatory Physiology, 309, H663-H675. https://doi.org/10.1152/ajpheart.00175.2015
[16]
Caro, C.G., Cheshire, N.J. and Watkins, N. (2005) Preliminary Comparative Study of Small Amplitude Helical and Conventional ePTFE Arteriovenous Shunts in Pigs. Journal of the Royal Society Interface, 2, 261-266. https://doi.org/10.1098/rsif.2005.0044
[17]
Gallo, D., Steinman, D.A., Bijari, P.B. and Morbiducci, U. (2012) Helical Flow in Carotid Bifurcation as Surrogate Marker of Exposure to Disturbed Shear. Journal of Biomechanics, 45, 2398-2404. https://doi.org/10.1016/j.jbiomech.2012.07.007
[18]
Cunnane, C.V., Cunnane, E.M., Moran, D.T. and Walsh, M.T. (2019) The Presence of Helical Flow Can Suppress Areas of Disturbed Shear in Parameterised Models of an Arteriovenous Fistula. International Journal for Numerical Methods in Biomedical Engineering, 35, e3259. https://doi.org/10.1002/cnm.3259
[19]
De Nisco, G., Kok, A.M., Chiastra, C., Gallo, D., Hoogendoorn, A., Migliavacca, F., Wentzel, J.J. and Morbiducci, U. (2019) The Atheroprotective Nature of Helical Flow in Coronary Arteries. Annals of Biomedical Engineering, 47, 425-438. https://doi.org/10.1007/s10439-018-02169-x
[20]
Bozzetto, M., Ene-Iordache, B. and Remuzzi, A. (2016) Transitional Flow in the Venous Side of Patient-Specific Arteriovenous Fistulae for Hemodialysis. Annals of Biomedical Engineering, 44, 2388-2401. https://doi.org/10.1007/s10439-015-1525-y
[21]
Ene-Iordache, B., Semperboni, C., Dubini, G. and Remuzzi, A. (2015) Disturbed Flow in a Patient-Specific Arteriovenous Fistula for Hemodialysis: Multidirectional and Reciprocating Near-Wall Flow Patterns. Journal of Biomechanics, 48, 2195-2200. https://doi.org/10.1016/j.jbiomech.2015.04.013
[22]
Lee, S.-W., Antiga, L. and Steinman, D.A. (2009) Correlations among Indicators of Disturbed Flow at the Normal Carotid Bifurcation. Journal of Biomechanical Engineering, 131, Article ID: 061013. https://doi.org/10.1115/1.3127252
[23]
Ene-Iordache, B., Cattaneo, L., Dubini, G. and Remuzzi, A. (2013) Effect of Anastomosis Angle on the Localization of Disturbed Flow in “Side-to-End” Fistulae for Haemodialysis Access. Nephrology Dialysis Transplantation, 28, 997-1005. https://doi.org/10.1093/ndt/gfs298
[24]
Chiu, J.-J. and Chien, S. (2011) Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives. Physiological Reviews, 91, 327-387. https://doi.org/10.1152/physrev.00047.2009
[25]
Ene-Iordache, B. and Remuzzi, A. (2012) Disturbed Flow in Radial-Cephalic Arteriovenous Fistulae for Haemodialysis: Low and Oscillating Shear Stress Locates the Sites of Stenosis. Nephrology Dialysis Transplantation, 27, 358-368. https://doi.org/10.1093/ndt/gfr342
[26]
Carroll, J., Varcoe, R.L., Barber, T. and Simmons, A. (2019) Reduction in Anastomotic Flow Disturbance within a Modified End-to-Side Arteriovenous Fistula Configuration: Results of a Computational Flow Dynamic Model. Nephrology, 24, 245-251. https://doi.org/10.1111/nep.13219
[27]
Rathore, S., Uda, T., Huynh, V.Q.H., Suito, H., Watanabe, T., Sugiyama, H. and Srikanth, D. (2021) Numerical Computation of Blood Flow for a Patient-Specific Hemodialysis Shunt Model. Japan Journal of Industrial and Applied Mathematics, 38, 903-919. https://doi.org/10.1007/s13160-021-00469-9
