An arteriovenous fistula (AVF) is the access most recommended by several authors. However, its manufacture and use can cause several problems in the short, medium and long term. The study of fluid dynamics related to the structure of the AVF can provide information necessary for the reduction of these problems and a better quality of life for patients. The present study analyzed pressure variation in a rigid and flexible (thickness variation) model of AVFs manufactured based on patient data. A computed tomography was performed from which the geometry of the AVF was removed. This was treated and adapted to the pulsatile flow bench. Bench tests with simulation of systolic–diastolic pulse showed higher pressure peaks in the rigid AVF followed by the flexible model with 1 mm thickness. The inflection of the pressure values of the flexible AVF in relation to the rigid one was observed, being more expressive in the flexible AVF of 1 mm. The 1 mm flexible AVF presented an average pressure close to the physiological one and a smaller pressure drop, showing that this AVF model presents the best condition among the three to serve as a basis for the development of an AVF substitute.
Arteriovenous fistula (AVF) is the most widely used vascular access by patients undergoing hemodialysis, however, even though the most widely used access to AVF has a high failure rate, and can be affected by problems during its use, among the most common highlights intimal hyperplasia, thrombosis and stenosis. Studies suggest that recurrent problems in this type of access are directly linked to geometry, flow conditions and stiffness of the vascular wall by the vessels that compose it. The present work seeks to analyze the variation of pressure and flow in rigid and flexible AVF models manufactured from data from an actual patient undergoing treatment. The study was carried out from the acquisition and processing of the patient's medical examinations (computed tomography), the creation of the geometry, treatment and modeling of said patient, the manufacturing of the AVF models by 3D printing and injection in mold, experimental analysis with pulsatile flow conditions, close to the real physiological conditions, and data analysis. The results obtained show the influence of vascular wall stiffness on flow conditions. In the rigid and flexible model, pressure peaks ranged from 170.98 mmHg to 172.44 mmHg (± 0.02) and 69.83 mmHg to 116.63 mmHg (± 0.03), respectively. The pressure drop between entry and exit in the AVF was also analyzed, presenting a greater value in the flexible model, being approximately three times that of the rigid model. The observed results show the direct relation of the deformation in the flow conditions in the system, and consequently, its direct influence on the pathologies of the vascular system, especially the AVF.
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