Suppressing Unsteady Flow in Arterio-Venous Fistulae

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Title: Suppressing Unsteady Flow in Arterio-Venous Fistulae
Authors: Grechy, L
Iori, F
Corbett, R
Shurey, S
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 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.
Issue Date: 9-Oct-2017
Date of Acceptance: 12-Sep-2017
ISSN: 1070-6631
Publisher: AIP Publishing
Journal / Book Title: Physics of Fluids
Volume: 29
Copyright Statement: © 2017 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY)
Sponsor/Funder: Engineering & Physical Science Research Council (EPSRC)
Imperial College Healthcare NHS Trust- BRC Funding
British Heart Foundation
Engineering & Physical Science Research Council (EPSRC)
Funder's Grant Number: EP/K503381/1
RDA04 79560
Keywords: 01 Mathematical Sciences
02 Physical Sciences
09 Engineering
Fluids & Plasmas
Publication Status: Published
Article Number: 101901
Appears in Collections:Faculty of Engineering
Faculty of Medicine

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