Reduction in anastomotic flow disturbance within a modified end‐to‐side arteriovenous fistula configuration: Results of a computational flow dynamic model. Issue 2 (29th January 2019)

• Record Type: Journal Article
• Authors: Carroll, John; Varcoe, Ramon L; Barber, Tracie; Simmons, Anne
• Is Part Of: Nephrology. Volume 24:Issue 2(2019)
• Page Start: 245
• Page End: 251
• Publication Date: 2019-01-29
• Subjects: arteriovenous fistula -- dialysis access surgery -- haemodynamics -- vascular remodelling; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13219
• Languages: English
• ISSNs: 1320-5358

Abstract

ABSTRACT: Aim: We sought to determine if a modification to the peri‐anastomotic vein configuration during end‐to‐side arteriovenous fistula (AVF) creation would achieve a favourable haemodynamic environment compared with the standard acute‐angle AVF. Methods: Computational fluid dynamics (CFD) modelling of two end‐to‐side AVF geometries (smooth‐vein‐loop vs. acute‐angle) allowed for haemodynamic modelling. Haemodynamic fields at various stages of the pulse cycle were observed and compared across both models. Results: We found a significant reduction in flow disturbance in the modified shape at the peri‐anastomotic vein region, a common site for stenosis. The acute anastomotic angle characteristic of a standard‐end‐to‐side AVF was found to cause significant flow disturbance throughout the pulse cycle. Conclusion: Computational modelling indicates that improvements in the haemodynamic environment of an AVF are achievable when a gentle change in direction is present in the vein segment. This may lead to improved maturation and AVF patency through reduction in disturbed flow patterns. Summary at a Glance: The authors have developed a computational fluid dynamics model to explore flow disturbances and local haemodynamic effects of the perianastomotic vein configuration following end‐to‐side arteriovenous‐fistula creation either with a standard acute angle or with a smooth vein loop angle. They found a significant reduction in flow disturbance in the modified shape (smooth vein angle) at the perianastomotic vein region compared to the acute angle. This study showed important aspects regarding blood access using a new model such as computational fluid dynamic model