Heterogeneity in the non-planarity and arterial curvature of arteriovenous fistulae in vivo
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Published version
Author(s)
Type
Journal Article
Abstract
Objective: Native arteriovenous fistulae (AVF) for haemodialysis are susceptible to non-maturation. Adverse features of local blood flow have been implicated in the formation of peri-anastomotic neointimal hyperplasia which may underpin non-maturation. While computational fluid dynamic simulations of idealised models highlight the importance of geometry on fluid and vessel wall interactions, little is known in vivo about AVF geometry and its role in adverse clinical outcomes. This study set out to examine the three-dimensional geometry of native AVF and the geometric correlates of AVF failure. Methods: As part of an observational study between 2013 and 2016, patients underwent creation of an upper limb AVF according to current surgical best practice. Phase-contrast MRI was performed on the day of surgery to obtain luminal geometry along with ultrasound measurements of flow. MRI datasets were segmented and reconstructed for quantitative and qualitative analysis of local geometry. Clinical maturation was evaluated at six weeks. Results: 60 patients were successfully imaged on the day of surgery. Radiocephalic (n=17), brachiocephalic (n=40) and brachiobasilic (n=3) fistulae were all included in the study. Centrelines extracted from segmented vessel lumen exhibited significant heterogeneity in arterial non-planarity and curvature. Furthermore, these features are more marked in brachiocephalic as compared to radiocephalic fistulae. Across the cohort, the projected bifurcation angle was was 73° (±16°) mean (±sd). Geometry was preserved at two weeks in 20 patients who underwent repeat imaging. A greater degree of arterial non-planarity (log odds ratio (logOR) 0.95 per 0.1/vessel diameter (95% CI 0.22 to 1.90, P= .03)) along with a larger bifurcation angle (logOR 0.05 per degree (95% CI 0.01 to 0.09, P= .02)) are associated with a great rate of maturation, as is fistula location (upper vs lower arm) logOR -1.9 (95% CI -3.2 to 0.7, P = .002) . Conclusions: There is significant heterogeneity in the three-dimensional geometry of arteriovenous fistulae, in particular, arterial non-planarity and curvature. In this largest cohort of AVF geometry to date, the effect of individual geometric correlates on maturation is uncertain but supports the premise that future modelling studies will need to acknowledge the complex geometry of AVF.
Date Issued
2018-01-01
Online Publication Date
2018-12
Date Acceptance
2018-04-02
ISSN
0741-5214
Publisher
Elsevier
Start Page
152s
End Page
163s
Journal / Book Title
Journal of Vascular Surgery
Volume
68
Issue
6, Supplement
Copyright Statement
© 2018 The Authors. Published by Elsevier Inc. on behalf of the Society for Vascular Surgery. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/4.0/).
https://doi.org/10.1016/j.jvs.2018.04.045
https://doi.org/10.1016/j.jvs.2018.04.045
Source Database
manual-entry
Sponsor
Engineering & Physical Science Research Council (EPSRC)
Engineering & Physical Science Research Council (EPSRC)
Grant Number
EP/K503381/1
AEDZ_P66791
Subjects
Arteriovenous fistula
Hemodialysis
Magnetic resonance imaging
Nonplanarity
Vascular geometry
11 Medical And Health Sciences
Cardiovascular System & Hematology
Publication Status
Published
Date Publish Online
2018-07-29