Novel Modular Anastomotic Valve Device for Hemodialysis Vascular Access: Preliminary Computational Hemodynamic Assessment

McNally, Andrew; Akingba, A. George; Robinson, E. A.; Sucosky, Philippe

doi:10.5301/jva.5000284

Cited by 12 publications

(11 citation statements)

References 54 publications

(68 reference statements)

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“…The former group include mutations of prothrombin (3), decreased concentration of plasma-activated protein C-protein C inhibitor complex (4), high red blood cell distribution width (5) and others. Development of neointimal hyperplasia in the venous anastomosis was linked to the graft-vein mismatch in wall elastic properties (6) or to the changes of wall shear stress (7).…”

Section: Introductionmentioning

confidence: 99%

Factors influencing dialysis arteriovenous graft survival

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Factors influencing dialysis arteriovenous graft survival

et al. 2017

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“…To treat the clinical problem of AVF maturation failure, both optimal geometric parameters and methods for controlling them to achieve these optimal values will be needed. For example, the anastomosis angle can be controlled with surgical technique [4] or with devices [21,22].…”

Section: Discussionmentioning

confidence: 99%

The Geometry of Arteriovenous Fistulas Using Endothelial Nitric Oxide Synthase Mouse Models

et al. 2020

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BackgroundArteriovenous fistula (AVF) maturation failure is a significant clinical problem in the hemodialysis population. Geometric parameters of human AVFs were associated with AVF development, but causative studies are lacking. We characterized mouse AVF geometry using endothelial nitric oxide synthase (NOS3) mouse models.MethodsCarotid-jugular AVFs were created in NOS3 overexpression (OE), knockout (KO), and wild-type (WT) mice. At 7 and 21 days postcreation, black-blood magnetic resonance images of AVFs were acquired and used to build three-dimensional reconstructions of AVF lumens. We used these reconstructions to calculate the lumen area, lumen centerline, and centerline-derived parameters: anastomosis angle, tortuosity, nonplanarity angle, and location of maximal distance between the feeding artery and AVF vein. Inter- and intrauser variabilities were also determined.ResultsWhen all mice were considered, increased minimum AVF venous lumen area was accompanied by increased venous tortuosity and increased distance between the artery and vein, with both remaining in plane with the anastomosis. At day 7, the lumen area of AVFs from all strains was 1.5- to 2.5-fold larger than native veins. Furthermore, at day 21, AVF lumen in NOS3 OE (4.04±1.43 mm2) was significantly larger than KO (2.74±1.34 mm2) (P<0.001) and WT (2.94±1.30 mm2) mice (P<0.001). At day 21, the location of maximal artery-vein distance on the vein was further away from the anastomosis in OE (4.49±0.66 mm) than KO (2.87±0.38 mm) (P=0.01). Other geometric parameters were not significantly different between mouse strains or time points. Inter- and intrauser variabilities were small, indicating the reliability and reproducibility of our protocol.ConclusionsOur study presents a detailed characterization of mouse AVF geometry, and a robust protocol for future mechanistic studies to investigate the role of molecular pathways in AVF geometry. Identifying a geometry related to desired AVF remodeling can help inform surgery to enhance AVF maturation.

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“…Recently, a modular anastomotic valve was designed to normalize venous flow between dialysis periods by isolating the graft from the circulation between dialysis periods (closed position) and enabling vascular access during dialysis (open position). This valve consequently decreases flow disturbances and the overall exposure of the graft-vein anastomosis to the high arterial flow, which theoretically could attenuate NIH progression (26). However, currently only CFD studies are available.…”

Section: Graft Geometry and Flow Modulationmentioning

confidence: 99%

Graft Modification Strategies to Improve Patency of Prosthetic Arteriovenous Grafts for Hemodialysis

2016

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Prosthetic arteriovenous grafts (AVGs) are indicated for vascular access for long-term hemodialysis in patients in whom creation or maintenance of an arteriovenous fistula (AVF) has failed or is contraindicated. AVGs have an inferior long-term patency as compared to AVFs. To ameliorate patency rates of prosthetic AVGs, different strategies have emerged to improve graft materials. This review aims to describe current strategies and future perspectives on graft modification, by graft geometry, drug coatings and graft surface technology, to improve AVG patency.

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Novel Modular Anastomotic Valve Device for Hemodialysis Vascular Access: Preliminary Computational Hemodynamic Assessment

Abstract: This study suggests the ability of the MAVD to normalize venous flow between dialysis periods while generating the typical hemodynamics of end-to-side vein-graft anastomoses during dialysis.

Cited by 12 publications

References 54 publications

Factors influencing dialysis arteriovenous graft survival

Factors influencing dialysis arteriovenous graft survival

The Geometry of Arteriovenous Fistulas Using Endothelial Nitric Oxide Synthase Mouse Models

Graft Modification Strategies to Improve Patency of Prosthetic Arteriovenous Grafts for Hemodialysis

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