The Effect of Arterial Curvature on Blood Flow in Arterio-Venous Fistulae: Realistic Geometries and Pulsatile Flow

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Title: The Effect of Arterial Curvature on Blood Flow in Arterio-Venous Fistulae: Realistic Geometries and Pulsatile Flow
Author(s): Grechy, L
Iori, F
Corbett, R
Gedroyc, W
Duncan, N
Caro, C
Vincent, PE
Item Type: Journal Article
Abstract: Arterio-Venous Fistulae (AVF) are regarded as the “gold standard” method of vascular access for patients with End-Stage Renal Disease (ESRD) who require haemodialysis. However, up to 60% of AVF do not mature, and hence fail, as a result of Intimal Hyperplasia (IH). Unphysiological flow and oxygen transport patterns, associated with the unnatural and often complex geometries of AVF, are believed to be implicated in the development of IH. Previous studies have investigated the effect of arterial curvature on blood flow in AVF using idealized planar AVF configurations and non-pulsatile inflow conditions. The present study takes an important step forwards by extending this work to more realistic non-planar brachiocephalic AVF configurations with pulsatile inflow conditions. Results show that forming an AVF by connecting a vein onto the outer curvature of an arterial bend does not, necessarily, suppress unsteady flow in the artery. This finding is converse to results from a previous more idealized study. However, results also show that forming an AVF by connecting a vein onto the inner curvature of an arterial bend can suppress exposure to regions of low wall shear stress and hypoxia in the artery. This finding is in agreement with results from a previous more idealized study. Finally, results show that forming an AVF by connecting a vein onto the inner curvature of an arterial bend can significantly reduce exposure to high WSS in the vein. The results are important, as they demonstrate that in realistic scenarios arterial curvature can be leveraged to reduce exposure to excessively low/high levels of WSS and regions of hypoxia in AVF. This may in turn reduce rates of IH and hence AVF failure.
Publication Date: 26-Jul-2017
Date of Acceptance: 7-Jul-2017
URI: http://hdl.handle.net/10044/1/50087
DOI: https://dx.doi.org/10.1007/s13239-017-0321-2
ISSN: 1869-4098
Publisher: Springer
Start Page: 313
End Page: 329
Journal / Book Title: Cardiovascular Engineering and Technology
Volume: 8
Issue: 3
Copyright Statement: © 2017 The Author(s). This article is an open access publication
Sponsor/Funder: British Heart Foundation
Funder's Grant Number: FS/14/19/30609
Keywords: AVF
Anastomosis
Arterio-Venous Fistula
Blood flow CFD
Blood flow unsteadiness
Haemodynamics
Hypoxia
Publication Status: Published
Appears in Collections:Faculty of Engineering
Division of Surgery
Aeronautics
Faculty of Medicine



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