Measurement of Hemodynamic and Anatomic Parameters in a Swine Arteriovenous Fistula Model

Krishnamoorthy, Mahesh; Roy‐Chaudhury, Prabir; Wang, Y; Roy, Abhijit Sinha; Zhang, J; Khoury, Saeb F.; Munda, Rino; Banerjee, Rupak K.

doi:10.1177/112972980800900105

Cited by 14 publications

(19 citation statements)

References 12 publications

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“…Based on their patency, autogenous end-to-side and side-to-side fistuals are the favored types of a-v fistulas, providing optimal vascular access (Krishnamoorthy et al, 2008;Besarab et al, 2007). Complications in the fistula and the adjoining vessels can cause loss of access patency, burdening the patients with the need for re-operative treatment conferring additional costs to the health sector (Besarab et al, 2007;Saran et al, 2008).…”

Section: Introductionmentioning

confidence: 98%

Can sites prone to flow induced vascular complications in a-v fistulas be assessed using computational fluid dynamics?

Niemann

Udesen

Thrysøe

et al. 2010

Journal of Biomechanics

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Section: Introductionmentioning

confidence: 98%

Can sites prone to flow induced vascular complications in a-v fistulas be assessed using computational fluid dynamics?

Niemann

Udesen

Thrysøe

et al. 2010

Journal of Biomechanics

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“…That low WSS is the major determinant of intimal thickness was demonstrated in vivo in dogs by Morinaga and colleagues in 1985 (34), who clearly showed that the change in WSS, but not the rate of blood flow, is the essential hemodynamic factor related to neointimal hyperplasia in autogenous vein grafts. Recently, a direct relation between low WSS profiles and patterns of neointimal hyperplasia was demonstrated in vivo in a pig model of AVF (35).…”

Section: Disturbed Flow As An Upstream Event In Neointimal Hyperplasiamentioning

confidence: 99%

Novel Paradigms for Dialysis Vascular Access

Remuzzi

Ene-Iordache

2013

Clinical Journal of the American Society of Nephrology

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SummaryFailure of hemodialysis access is caused mostly by venous intimal hyperplasia, a fibro-muscular thickening of the vessel wall. The pathogenesis of venous neointimal hyperplasia in primary arteriovenous fistulae consists of processes that have been identified as upstream and downstream events. Upstream events are the initial events producing injury of the endothelial layer (surgical trauma, hemodynamic shear stress, vessel wall injury due to needle punctures, etc.). Downstream events are the responses of the vascular wall at the endothelial injury that consist of a cascade of processes including leukocyte adhesion, migration of smooth muscle cells from the media to the intimal layer, and proliferation. In arteriovenous fistulae, the stenoses occur in specific sites, consistently related to the local hemodynamics determined by the vessel geometry and blood flow pattern. Recent findings that the localization of these sites matches areas of disturbed flow may add new insights into the pathogenesis of neointimal hyperplasia in the venous side of vascular access after the creation of the anastomosis. The detailed study of fluid flow motion acting on the vascular wall in anastomosed vessels and in the arm vasculature at the patient-specific level may help to elucidate the role of hemodynamics in vascular remodeling and neointimal hyperplasia formation. These computational approaches may also help in surgical planning for the amelioration of clinical outcome. This review aims to discuss the role of the disturbed flow condition in acting as upstream event in the pathogenesis of venous intimal hyperplasia and in producing subsequent local vascular remodeling in autogenous arteriovenous fistulae used for hemodialysis access. The potential use of blood flow analysis in the management of vascular access is also discussed.

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“…MATERIALS AND METHODS AV fistula creation AV fistulae were created in two different configurations, namely, curved and straight, between the femoral artery and femoral vein in eight pigs, each weighing about 50 kg. 10 As surgical skills have been shown to be a determinant of AV fistula success or failure in the human setting, all the surgeries were performed by a single surgeon (YW).…”

Section: Discussionmentioning

confidence: 99%

“…7 At a radiological level, AV fistula non-maturation is characterized by a peri-anastomotic venous segment stenosis. 8 At a mechanistic level, the exact reasons for either AV fistula success (maturation) or failure (non-maturation) are unclear, but it is likely that the magnitude of stenosis is influenced, both by the amount of neointimal hyperplasia 9,10 and also by the ability or inability of the venous segment to dilate following creation of the AV anastomosis.…”

mentioning

confidence: 99%

Anatomic configuration affects the flow rate and diameter of porcine arteriovenous fistulae

Krishnamoorthy

Banerjee

Wang

et al. 2012

Kidney International

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Although arteriovenous fistulae are currently the preferred form of vascular access, early failure is a significant problem. Since wall shear stress is thought to play an important role in the pathogenesis of early failure, and this stress varies markedly in different fistula configurations, we assessed the influence of configuration (curved or straight) on longitudinal changes of flow rate and lumen diameter in a porcine fistula model. Fistulae were created in eight pigs between the femoral artery and vein, with each animal having a curved and a straight configuration on opposite sides. Velocity measurements were obtained by ultrasound at the time of surgery and at intermediate time points up to 28 days. Quantification of both the configuration and the internal diameter of the fistulae was determined by CT scans. The overall rate of increased flow during each time interval (0 to 2 days, 2 to 7 days, and 7 to 28 days) was more pronounced with the curved fistulae. Moreover, the luminal diameter of curved fistulae had dilated more from the time of surgery to 28 days as compared to the straight fistulae. Thus, anatomical configuration of fistulae plays a major role in flow-mediated dilatation. Identifying the optimal configuration may result in increased diameter and consequently blood flow, and perhaps reduce the incidence of early failure.

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Measurement of Hemodynamic and Anatomic Parameters in a Swine Arteriovenous Fistula Model

Cited by 14 publications

References 12 publications

Can sites prone to flow induced vascular complications in a-v fistulas be assessed using computational fluid dynamics?

Can sites prone to flow induced vascular complications in a-v fistulas be assessed using computational fluid dynamics?

Novel Paradigms for Dialysis Vascular Access

Anatomic configuration affects the flow rate and diameter of porcine arteriovenous fistulae

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