A cohort study showing correspondence of low wall shear stress and cephalic arch stenosis in brachiocephalic arteriovenous fistula access

Hammes, Mary; Cassel, Kevin W.; Boghosian, Michael; Watson, Sydeaka; Funaki, Brian; Coe, F. L.

doi:10.1177/1129729820942048

Cited by 9 publications

(9 citation statements)

References 40 publications

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“…These asymmetries in velocity profile lead us to predict two regions of abnormal WSS, one directly in the inner wall of the bend region, and the other at the beginning of the post-bend region, but along the outer wall of the CA. These predictions match a similar study in 2D [14].…”

Section: Simulating Flow In 3d Idealized Computational Models Of Cephalic Archsupporting

confidence: 92%

“…Patients were consented to enroll in the study if they had advanced renal failure or were on hemodialysis in need of a permanent access with a BCF planned. During the study 161 patients consented, but only 40 completed the study [14]. Five subjects were chosen from the 161 consented for inclusion in the study as we selected subjects with presumed normal anatomic configuration of the BCF without previous catheter access on the side of the BCF (Fig 2).…”

Section: Trial Design and Protocolmentioning

confidence: 99%

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Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis

et al. 2021

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Background The most common configuration for arteriovenous fistula is brachiocephalic which often develop cephalic arch stenosis leading to the need for numerous procedures to maintain access patency. The hemodynamics that contributes to the development of cephalic arch stenosis is incompletely understood given the inability to accurately determine shear stress in the cephalic arch. In the current investigation our aim was to determine pressure, velocity and wall shear stress profiles in the cephalic arch in 3D using computational modeling as tools to understand stenosis. Methods Five subjects with brachiocephalic fistula access had protocol labs, Doppler, venogram and intravascular ultrasound imaging performed at 3 and 12 months. 3D reconstructions of the cephalic arch were generated by combining intravascular ultrasounds and venograms. Standard finite element analysis software was used to simulate time dependent blood flow in the cephalic arch with velocity, pressure and wall shear stress profiles generated. Results Our models generated from imaging and flow measurements at 3 and 12 months offer snapshots of the patient’s cephalic arch at a precise time point, although the remodeling of the vessel downstream of an arteriovenous fistula in patients undergoing regular dialysis is a dynamic process that persists over long periods of time (~ 5 years). The velocity and pressure increase at the cephalic bend cause abnormal hemodynamics most prominent along the inner wall of the terminal cephalic arch. The topology of the cephalic arch is highly variable between subjects and predictive of pathologic stenosis at later time points. Conclusions Low flow velocity and wall pressure along the inner wall of the bend may provide possible nidus of endothelial activation that leads to stenosis and thrombosis. In addition, 3D modelling of the arch can indicate areas of stenosis that may be missed by venograms alone. Computational modeling reconstructed from 3D radiologic imaging and Doppler flow provides important insights into the hemodynamics of blood flow in arteriovenous fistula. This technique could be used in future studies to determine optimal flow to prevent endothelial damage for patients with arteriovenous fistula access.

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Section: Simulating Flow In 3d Idealized Computational Models Of Cephalic Archsupporting

confidence: 92%

Section: Trial Design and Protocolmentioning

confidence: 99%

Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis

et al. 2021

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“…23,24 Studies using computational modeling revealed that WSS is lower than normal in the curved area of the cephalic arch. 25,26 In a recent study, 27 location and percent low WSS in the arch was determined using computational hemodynamics modeling at the time of fistula maturation in 40 patients with BCFs to see the relationship between WSS at time of maturation and location of cephalic arch stenosis. The study revealed that out of the 32 patients who developed CAS, 26 patients displayed correspondence between low WSS at time of maturation and CAS.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate

Kim

Chung

et al. 2021

J Vasc Access

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Objective: Despite the widespread use of conventional percutaneous transluminal angioplasty (PTA), recurrence of cephalic arch stenosis (CAS), and low patency rate after PTA remain challenging problem. We aimed to identify the clinical predictors of recurrence of CAS and evaluate the effect of the access flow reduction on the fistula patency rate in patients with recurrent CAS. Methods: In 1118 angiographies of 220 patients with CAS, access circuit patency rates after PTA and potential clinical predictors of recurrence of CAS were assessed. The effect of the banding procedure was evaluated in terms of post-interventional primary patency rate, and the number of interventions per access-year. Results: At 3, 6, and 12 months after the first PTA on CAS, the post-interventional access circuit primary patency rates were 68.8%, 40.5%, and 25.1%, respectively. High CV to CA ratio (the ratio of the maximal diameter of the distal cephalic vein to the diameter of the cephalic arch) (Hazard ratio (HR), 1.437; 95% confidence interval (CI), 1.036–1.992) and involvement of the proximal segment of cephalic arch (HR, 1.828; 95% CI, 1.194–2.801) were significant predictors of recurrent CAS. For those with recurrent CAS (>3 times/year) and an access flow rate >1.5 L/minute, endovascular banding procedure was performed. The banding procedure significantly reduced the number of interventions per access-year ( t = 3.299, p = 0.005 and t = 2.989, p = 0.007, respectively). Post-interventional access circuit primary patency rate after banding was significantly higher than that before banding ( p = 0.01). Conclusions: High CV to CA ratio and involvement of the proximal segment of the cephalic arch are independent clinical predictors of recurrent CAS. Endovascular banding might delay recurrence of CAS in patients with high CV to CA ratio and high access flow.

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“…8 Consistent with the findings of He et al, 4 low WSS was associated with cephalic arch stenosis in upper-arm AVFs. 9 He et al 4 outline some significant limitations of their study, which rely on several theoretical assumptions for constructing their model. Most importantly, they limited their analysis to AVF remodeling rather than evaluating AVF clinical maturation.…”

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confidence: 99%

“…8 Consistent with the findings of He et al , 4 low WSS was associated with cephalic arch stenosis in upper-arm AVFs. 9…”

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confidence: 99%

Pathophysiology of Arteriovenous Fistula Maturation and Nonmaturation

Gallieni

Sabiu

2023

CJASN

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A cohort study showing correspondence of low wall shear stress and cephalic arch stenosis in brachiocephalic arteriovenous fistula access

Cited by 9 publications

References 40 publications

Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis

Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis

Clinical predictors of recurrent cephalic arch stenosis and impact of the access flow reduction on the patency rate

Pathophysiology of Arteriovenous Fistula Maturation and Nonmaturation

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