Numerical and experimental study of blood flow through a patient-specific arteriovenous fistula used for hemodialysis

Kharboutly, Zaher; Deplano, Valérie; Bertrand, Éric; Legallais, Cécile

doi:10.1016/j.medengphy.2009.10.013

Cited by 43 publications

(39 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

“…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. As in good functioning AVFs the Reynolds number is high, CFD has been validated against in vitro measurements by particle image velocimetry (42) in AVF models. All of these studies found high WSS, especially very high near the anastomosis, but did not find disturbed flow patterns on the AVF walls.…”

Section: Disturbed Flow Patterns In the Avfmentioning

confidence: 99%

See 1 more Smart Citation

Novel Paradigms for Dialysis Vascular Access

Remuzzi

Ene-Iordache

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

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.

show abstract

Section: Disturbed Flow Patterns In the Avfmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…The resulting Womersley number was 6.9. All flow was prescribed normal to the PAI inflow plane, and in line with previous studies, 54,56,77 a Womersley profile was imposed in space. The PAI inflow rate Q PAI as a function of time is shown in Fig.…”

Section: B Governing Equations and Boundary Conditionsmentioning

confidence: 99%

“…25 More recent work, undertaken specifically in the context of vascular fluid mechanics, includes studies of stenotic flows, 26 pulsatile flow in curved pipes, [27][28][29][30] flow in helical pipes, [31][32][33][34] and flow at junctions. [35][36][37] In terms of simulating flow in AVF configurations, there have been a range of previous Computational Fluid Dynamics (CFD) studies, including 1D simulations, [38][39][40] 2D simulations, 41 3D simulations with rigid walls in idealised geometries, [42][43][44][45][46][47] 3D simulations with rigid walls in more realistic geometries, [48][49][50][51][52][53][54][55] and simulations with distensible walls. 56 Of these studies, several investigated flow unsteadiness.…”

Section: Introductionmentioning

confidence: 99%

Suppressing unsteady flow in arterio-venous fistulae

et al. 2017

View full text Add to dashboard Cite

Arterio-Venous Fistulae (AVF) are regarded as the “gold standard” method of vascular access for patients with end-stage renal disease who require haemodialysis. However, a large proportion of AVF do not mature, and hence fail, as a result of various pathologies such as Intimal Hyperplasia (IH). Unphysiological flow patterns, including high-frequency flow unsteadiness, associated with the unnatural and often complex geometries of AVF are believed to be implicated in the development of IH. In the present study, we employ a Mesh Adaptive Direct Search optimisation framework, computational fluid dynamics simulations, and a new cost function to design a novel non-planar AVF configuration that can suppress high-frequency unsteady flow. A prototype device for holding an AVF in the optimal configuration is then fabricated, and proof-of-concept is demonstrated in a porcine model. Results constitute the first use of numerical optimisation to design a device for suppressing potentially pathological high-frequency flow unsteadiness in AVF.

show abstract

“…This is of much importance for inserting the second dialysis needle outside the so-called recirculation zone, that is at a distance of 3-5 cm from the first needle. A shorter distance between the dialysis needles is associated with a risk of purified blood returning to the dialyzer system, which significantly reduces the efficiency of hemodialysis treatment [22]. Distal AVF provides a chance of subsequent creation of secondary forearm fistulas.…”

Section: Andrzej Berszakiewicz Et Al Arteriovenous Fistula For Dialmentioning

confidence: 99%