A significant number of arteriovenous fistulae (AVFs) fail to mature to support hemodialysis. Hemodynamic parameters, mainly wall shear stress (WSS), are believed to play a crucial role in the maturation or failure of AVFs. Our goal is to study the effects of the AVF configuration on the WSS profile. Idealized AVFs with 90°, 60°, and 30° anastomotic angles were created based on our previous experimental data from an in-vivo swine model . The hemodynamic parameters were then obtained using numerical techniques under steady state condition. The average WSS values for our models were within range of the swine model average WSS (= 174.9±64.6 dyne/cm 2). For all AVFs, WSS was higher along the bend. The highest WSS occurred on the outer wall (OW) of the 30° AVF (= 613 dyne/cm 2) compared to the 60° (= 407 dyne/cm 2) and 90° AVFs (= 329 dyne/cm 2). WSS on the inner wall (IW) of the bend was negative with the smallest magnitude in the 90° AVF (= −91 dyne/cm 2) compared to the 60° (= −172 dyne/cm 2) and 30° AVFs (= −169 dyne/cm 2). In addition, the maximum difference in WSS (ΔWSS: measure of axial WSS gradient) was less for the 90° AVF (= 158 dyne/cm 2) than the 60° (= 170 dyne/cm 2) and 30° AVFs (= 414 dyne/cm 2). A similar trend was found on the OW with ΔWSS of 161, 405, and 870 dyne/cm 2 for the 90°, 60°, 30° AVF, respectively. Moreover, AVFs with different angles can be categorized based on Dean number ( De) which showed an inverse correlation to WSS range. Thus, creating an AVF with a surgical configuration that results in a low De, representing a sharp bend with large radius of curvature, could result in a hemodynamic condition (high WSS and ΔWSS) that could have adverse effects on the fistula maturation.
- Bioengineering Division
Effect of the Anastomotic Angle on the Wall Shear Stress Profiles in the Arteriovenous Fistulae
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Conners, BM, Rajabi-Jaghargh, E, & Banerjee, RK. "Effect of the Anastomotic Angle on the Wall Shear Stress Profiles in the Arteriovenous Fistulae." Proceedings of the ASME 2013 Summer Bioengineering Conference. Volume 1B: Extremity; Fluid Mechanics; Gait; Growth, Remodeling, and Repair; Heart Valves; Injury Biomechanics; Mechanotransduction and Sub-Cellular Biophysics; MultiScale Biotransport; Muscle, Tendon and Ligament; Musculoskeletal Devices; Multiscale Mechanics; Thermal Medicine; Ocular Biomechanics; Pediatric Hemodynamics; Pericellular Phenomena; Tissue Mechanics; Biotransport Design and Devices; Spine; Stent Device Hemodynamics; Vascular Solid Mechanics; Student Paper and Design Competitions. Sunriver, Oregon, USA. June 26–29, 2013. V01BT58A003. ASME. https://doi.org/10.1115/SBC2013-14405
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