Investigations into the relationship between hemodynamics and vascular alterations in an established arteriovenous fistula

Kharboutly, Zaher; Fenech, Marianne; Treutenaere, J.M.; Claude, I.; Legallais, Cécile

doi:10.1016/j.medengphy.2006.10.018

Cited by 49 publications

(46 citation statements)

References 29 publications

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“…deformations and stresses in vascular tissue and graft wall. With the prediction of flow pattern and wall shear stress, 15,16,21,22,26,40 CFD allows the assessment of one important trigger of intimal hyperplasia. However, studies of vein grafts indicated that increased circumferential deformation and stress, respectively, in the vessel wall is an additional trigger of vein graft failure.…”

Section: Discussionmentioning

confidence: 99%

“…Van Tricht et al 41 used CFD to compare the hemodynamics in a straight and tapered AV graft. Kharboutly et al 15,16 conducted patient-specific CFD simulations and in vivo experiments to investigate the fluid mechanics in an AV fistula and the role of flow pattern in pathological alterations of the vascular wall. CFD has also been employed to investigate anastomotic regions of bypass grafts.…”

Section: Introductionmentioning

confidence: 99%

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A Numerical Tool for the Coupled Mechanical Assessment of Anastomoses of PTFE Arterio-venous Access Grafts

Ngoepe

Reddy

Kahn

et al. 2011

Cardiovasc Eng Tech

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The anastomotic angle is assumed to affect the performance of arterio-venous (AV) access grafts by altering wall shear stress (WSS) and wall tension. The objective of this study was to develop a coupled numerical tool to assess fluid and structural anastomotic mechanics of a straight upper arm access graft. 3D computational fluid dynamics (CFD) and finite element (FE) models were developed for arterial and venous anastomoses with different graft attachment angles. The fluid simulations were executed using flow velocity profiles for anastomotic inlets obtained from a whole-graft CFD model. A mesh adaptation algorithm was developed to couple CFD and FE meshes and capture fluid structure interactions. The coupling algorithm enabled transfer of blood pressure (BP) and WSS predicted with the CFD models to the FE models as loadings. The deformations induced in the FE models were used to update the CFD geometries after which BP and WSS were recalculated and the process repeated until equilibrium between fluid and solid models. Maximum BP in the vein was 181 mmHg. WSS peaked at 2.3 and 0.7 Pa and the structural wall stress reached 3.38 and 3.36 kPa in arterial and venous anastomosis. Since flow-induced wall tension has been identified as a contributor to access graft failure along with WSS, the computational tool will be useful in studying the coupled mechanics in these grafts. Initial investigations of arterial and venous anastomotic end-to-side configuration indicated a slightly better performance of the 90°configuration over 135°a rterial and 45°venous configurations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Numerical Tool for the Coupled Mechanical Assessment of Anastomoses of PTFE Arterio-venous Access Grafts

Ngoepe

Reddy

Kahn

et al. 2011

Cardiovasc Eng Tech

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“…Among the upstream events that may contribute to neointimal hyperplasia formation, the hemodynamic shear stress at the AVF anastomosis was investigated in several CFD studies in the last decade (40)(41)(42)(43). Numerical analysis of flow velocity has been validated with established experimental data (44), even for high values of the Reynolds number, an index of flow instability or turbulence.…”

Section: Disturbed Flow Patterns In the Avfmentioning

confidence: 99%

Novel Paradigms for Dialysis Vascular Access

Remuzzi

Ene-Iordache

2013

Clinical Journal of the American Society of Nephrology

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SummaryFailure of hemodialysis access is caused mostly by venous intimal hyperplasia, a fibro-muscular thickening of the vessel wall. The pathogenesis of venous neointimal hyperplasia in primary arteriovenous fistulae consists of processes that have been identified as upstream and downstream events. Upstream events are the initial events producing injury of the endothelial layer (surgical trauma, hemodynamic shear stress, vessel wall injury due to needle punctures, etc.). Downstream events are the responses of the vascular wall at the endothelial injury that consist of a cascade of processes including leukocyte adhesion, migration of smooth muscle cells from the media to the intimal layer, and proliferation. In arteriovenous fistulae, the stenoses occur in specific sites, consistently related to the local hemodynamics determined by the vessel geometry and blood flow pattern. Recent findings that the localization of these sites matches areas of disturbed flow may add new insights into the pathogenesis of neointimal hyperplasia in the venous side of vascular access after the creation of the anastomosis. The detailed study of fluid flow motion acting on the vascular wall in anastomosed vessels and in the arm vasculature at the patient-specific level may help to elucidate the role of hemodynamics in vascular remodeling and neointimal hyperplasia formation. These computational approaches may also help in surgical planning for the amelioration of clinical outcome. This review aims to discuss the role of the disturbed flow condition in acting as upstream event in the pathogenesis of venous intimal hyperplasia and in producing subsequent local vascular remodeling in autogenous arteriovenous fistulae used for hemodialysis access. The potential use of blood flow analysis in the management of vascular access is also discussed.

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“…However, verification of the results obtained is essential (Ene-Iordache et al, 2002;Migliavacca and Dubini, 2005). Previous studies have evaluated fistulas using CFD (Migliavacca and Dubini, 2005;Kharboutly et al, 2007;Van Tricht et al, 2006;Krueger et al, 2002;Ene-Iordache et al, 2001). However, these studies were not validated using experimental data.…”

Section: Introductionmentioning

confidence: 99%

Can sites prone to flow induced vascular complications in a-v fistulas be assessed using computational fluid dynamics?

Niemann

Udesen

Thrysøe

et al. 2010

Journal of Biomechanics

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Investigations into the relationship between hemodynamics and vascular alterations in an established arteriovenous fistula

Cited by 49 publications

References 29 publications

A Numerical Tool for the Coupled Mechanical Assessment of Anastomoses of PTFE Arterio-venous Access Grafts

A Numerical Tool for the Coupled Mechanical Assessment of Anastomoses of PTFE Arterio-venous Access Grafts

Novel Paradigms for Dialysis Vascular Access

Can sites prone to flow induced vascular complications in a-v fistulas be assessed using computational fluid dynamics?

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