Patterns of Blood Flow as a Predictor of Maturation of Arteriovenous Fistula for Haemodialysis

Marie, Yazin; Guy, A. J.; Tullett, Karen; Krishnan, Hari B.; Jones, Robert G.; Inston, Nicholas

doi:10.5301/jva.5000214

Cited by 30 publications

(25 citation statements)

References 30 publications

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“…Inherent and acquired factors related to vascular dysfunction, such as female sex, diabetes, age older than 65 years, history of peripheral vascular disease, and coronary artery disease, have been linked to early fistula failure. [4][5][6] Moreover, anatomical and surgical factors directly affect the functional outcome. Absence of suitable vascular anatomy, inadequate surgical technique during mobilization of the vein, and lack of surgical expertise have all been identified as contributing factors in AVF failures.…”

Section: Discussionmentioning

confidence: 99%

An Implanted Blood Vessel Support Device for Arteriovenous Fistulas: A Randomized Controlled Trial

Karydis

Bevis

Beckitt

et al. 2020

American Journal of Kidney Diseases

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Reducing turbulent blood flow through dialysis arteriovenous fistulas (AVFs) and radial stretching of their venous wall may attenuate hyperplasia and stenosis and improve AVF outcomes in hemodialysis patients. The goal of this study was to evaluate the safety and efficacy of the VasQ implant, which intervenes on these mechanisms by physically supporting the surgical arteriovenous anastomosis. Complete author and article information provided before references.

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Section: Discussionmentioning

confidence: 99%

An Implanted Blood Vessel Support Device for Arteriovenous Fistulas: A Randomized Controlled Trial

Karydis

Bevis

Beckitt

et al. 2020

American Journal of Kidney Diseases

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“…In clinical practice, these parameters cannot be reliably measured in an outpatient setting. Recent investigation has defined the type of blood flow in a fistula as an important determinate in maturation [ 54 ]. Cannulation techniques and skills must improve.…”

Section: Future Directionsmentioning

confidence: 99%

Hemodynamic and Biologic Determinates of Arteriovenous Fistula Outcomes in Renal Failure Patients

Hammes

2015

BioMed Research International

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The outcome of patients with end-stage renal disease on hemodialysis depends on a functioning vascular access. Although a variety of access options are available, the arteriovenous fistula remains the best vascular access. Unfortunately the success rate of mature fistula use remains poor. The creation of an arteriovenous fistula is followed by altered hemodynamic and biological changes that may result in neointimal hyperplasia and eventual venous stenosis. This review provides an overview of these changes and the needed research to provide a long lasting vascular access and hence improve outcomes for patients with end-stage renal disease.

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“…The characteristics of fluidic flow include laminar and disturbed flow, and fluid shear stress increases as the flow become disturbed ( Chien, 2007 ; Chiu and Chien, 2011 ). Cell experiments indicated that laminar flow increases endothelial cell survival, whereas disturbed flow leads to endothelial dysfunction ( Chien, 2008a , b ), followed by smooth muscle cell proliferation and intimal migration ( Paszkowiak and Dardik, 2003 ; Marie et al, 2014 ). Our results demonstrated that among the five different locations of AVF, the highest disturbed flow occurs at the stenotic lesion site.…”

Section: Discussionmentioning

confidence: 99%

The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography

Yang

Lan

et al. 2020

Front. Bioeng. Biotechnol.

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The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations using standardized AVF geometry, not the real-world patient images. The present study is the first CFD study to use angiographic images with patient-specific outcome information, i.e., the exact location of the AVF stenotic lesion. We conducted the CFD analysis utilizing patient-specific AVF geometric models to investigate hemodynamic parameters at different locations of an AVF, and the association between hemodynamic parameters and the anastomotic angle, particularly at the stenotic location. We analyzed 27 patients who used radio-cephalic AVF for hemodialysis and received an angiographic examination for juxta-anastomotic stenosis. The three-dimensional geometrical model of each patient’s AVF was built using the angiographic images, in which the shape and the anastomotic angle of the AVF were depicted. CFD simulations of AVF hemodynamics were conducted to obtain blood flow parameters at different locations of an AVF. We found that at the location of the stenotic lesion, the AV angle was significantly correlated with access flow disturbance ( r = 0.739; p < 0.001) and flow velocity ( r = 0.563; p = 0.002). Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that the AV angle determines the lesion’s flow disturbance with a high area under the curve value of 0.878. The ROC analysis also identified a cut-off value of the AV angle as 46.5°, above or below which the access flow disturbance was significantly different. By applying CFD analysis to real-world patient images, the present study provides evidence that an anastomotic angle wider than 46.5° might lead to disturbed flow generation, demonstrating a reference angle to adopt during the anastomosis surgery.

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Patterns of Blood Flow as a Predictor of Maturation of Arteriovenous Fistula for Haemodialysis

Abstract: SLF was strongly supportive of successful fistula maturation. A "thrill" was characteristic of spiral rather than turbulence. The mechanism of this apparent beneficial effect of this pattern of flow requires further investigation.

Cited by 30 publications

References 30 publications

An Implanted Blood Vessel Support Device for Arteriovenous Fistulas: A Randomized Controlled Trial

An Implanted Blood Vessel Support Device for Arteriovenous Fistulas: A Randomized Controlled Trial

Hemodynamic and Biologic Determinates of Arteriovenous Fistula Outcomes in Renal Failure Patients

The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography

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