Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients

Caroli, Anna; Manini, Simone; Antiga, Luca; Passera, Katia M.; Ene-Iordache, Bogdan; Rota, Stefano; Remuzzi, Giuseppe; Bode, A.S.; Leermakers, Jaap; Vosse, F.N. van de; Vanholder, Raymond; Malovrh, Marko; Tordoir, Jan H.M.; Remuzzi, Andrea

doi:10.1038/ki.2013.188

Cited by 69 publications

(88 citation statements)

References 29 publications

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“…The mean AVF vein diameter and blood flow rate increased progressively over 6 weeks, which is similar to findings from other small single-center studies in forearm (1-3,15,16) and upper-arm (17) AVFs. Interestingly, 55% of forearm AVFs and 83% of upper-arm AVFs reached at least 50% of the 6-week blood flow rate measurements at 1 day, which is similar to findings in three small previous studies (4,18,19), only one including upper-arm AVF. Collectively, our large data set and the literature indicate that substantial increases in blood flow and dilation of the vein occur within a day of AVF creation.…”

Section: Discussionsupporting

confidence: 78%

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Robbin¹,

Greene²,

Cheung³

et al. 2016

Radiology

109

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Section: Discussionsupporting

confidence: 78%

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Robbin¹,

Greene²,

Cheung³

et al. 2016

Radiology

109

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“…On the basis of demographic and clinical data, it is possible to predict the expected blood flow along the vascular network that will develop with time. We recently reported the results of the validation of this application (63), comparing the calculated vascular access flow with that measured in a group of 63 patients during a follow-up period of 6 weeks. We thus propose using this approach in the clinical routine to perform computer-based planning of AVF surgery using a fast and distributed computer infrastructure (http:/ /avfsim.herokuapp.com).…”

Section: Avf Surgery Planningmentioning

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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“…The parameterisation and constraints were chosen to ensure that the resulting geometry had clinical/anatomical relevance. Specifically, the artery to vein diameter ratio of 1:1 is in line with various measurements made post AVF surgery, 38,68 the maximum venous curvature of 1.8/D a is in line with measurements of maximum curvature in aneurysmatic internal carotid arteries, 69 and the restriction to fit within a cylinder of radius 7.5D a is in line with measurements of average human arm radius. 70 A schematic illustration of the arterial and venous centrelines is shown in Fig.…”

Section: B Parameterisationmentioning

confidence: 51%

“…This resulted in a Reynolds number of 800 at the PAI and an 80:20 flow split between the DVO and DAO for each configuration. 38,71 Finally, a constant (and arbitrary) pressure was applied at the DVO of each configuration, and a zero-velocity no-slip condition was applied at the arterial and venous walls, which were assumed to be rigid.…”

Section: Definitionmentioning

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%

See 1 more Smart Citation

Suppressing unsteady flow in arterio-venous fistulae

et al. 2017

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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.

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Validation of a patient-specific hemodynamic computational model for surgical planning of vascular access in hemodialysis patients

Abstract: Caroli, A.; Manini, S.; Antiga, L.; Passera, K.; Ene-Iiordache, B.; Rota, S.; Remuzzi, G.; Bode, A.S.; Leermakers, J.; van de Vosse, F.N.; Vanholder, R.; Malovrh, M.; Tordoir, J.; Remuzzi, A.

Cited by 69 publications

References 29 publications

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Arteriovenous Fistula Development in the First 6 Weeks after Creation

Novel Paradigms for Dialysis Vascular Access

Suppressing unsteady flow in arterio-venous fistulae

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