Maintaining vascular access (VA) patency continues to be the greatest challenge for dialysis patients. VA dysfunction, primarily due to venous neointimal hyperplasia development and stenotic lesion formation, is mainly attributed to complex hemodynamics within the arteriovenous fistula (AVF). The effect of VA creation and the subsequent geometrical remodeling on the hemodynamics and shear forces within a mature patient-specific AVF is investigated. A 3D reconstructed geometry of a healthy vein and a fully mature patient-specific AVF was developed from a series of 2D magnetic resonance image scans. A previously validated thresholding technique for region segmentation and lumen cross section contour creation was conducted in MIMICS 10.01, allowing for the creation of a 3D reconstructed geometry. The healthy vein and AVF computational models were built, subdivided, and meshed in GAMBIT 2.3. The computational fluid dynamic (CFD) code FLUENT 6.3.2 (Fluent Inc., Lebanon, NH) was employed as the finite volume solver to determine the hemodynamics and shear forces within the healthy vein and patient-specific AVF. Geometrical alterations were evaluated and a CFD analysis was conducted. Substantial geometrical remodeling was observed, following VA creation with an increase in cross-sectional area, out of plane curvature (maximum angle of curvature in ), and angle of blood flow entry. The mean flow velocity entering the vein of the AVF is dramatically increased. These factors result in complex three-dimensional hemodynamics within VA junction (VAJ) and efferent vein of the AVF. Complex flow patterns were observed and the maximum and mean wall shear stress (WSS) magnitudes are significantly elevated. Flow reversal was found within the VAJ and efferent vein. Extensive geometrical remodeling during AVF maturation does not restore physiological hemodynamics to the VAJ and venous conduit of the AVF, and high WSS and WSS gradients, and flow reversal persist. It is theorized that the vessel remodelling and the continued non-physiological hemodynamics within the AVF compound to result in stenotic lesion development.
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e-mail: grainne.carroll@ul.ie
e-mail: tim.mcgloughlin@ul.ie
e-mail: michael.walsh@ul.ie
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February 2011
Research Papers
Wall Shear Stresses Remain Elevated in Mature Arteriovenous Fistulas: A Case Study
G. T. Carroll,
G. T. Carroll
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, and the Materials and Surface Science Institute,
e-mail: grainne.carroll@ul.ie
University of Limerick
, Limerick, Ireland
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T. M. McGloughlin,
T. M. McGloughlin
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, and the Materials and Surface Science Institute,
e-mail: tim.mcgloughlin@ul.ie
University of Limerick
, Limerick, Ireland
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P. E. Burke,
P. E. Burke
Department of Vascular Surgery,
HSE Midwestern Regional Hospital
, Limerick, Ireland; St John’s Hospital
, Limerick, Ireland
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M. Egan,
M. Egan
Department of Radiology,
HSE Midwestern Regional Hospital
, Limerick, Ireland
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F. Wallis,
F. Wallis
Department of Radiology,
HSE Midwestern Regional Hospital
, Limerick, Ireland
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M. T. Walsh
M. T. Walsh
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, and the Materials and Surface Science Institute,
e-mail: michael.walsh@ul.ie
University of Limerick
, Limerick, Ireland
Search for other works by this author on:
G. T. Carroll
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, and the Materials and Surface Science Institute,
University of Limerick
, Limerick, Irelande-mail: grainne.carroll@ul.ie
T. M. McGloughlin
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, and the Materials and Surface Science Institute,
University of Limerick
, Limerick, Irelande-mail: tim.mcgloughlin@ul.ie
P. E. Burke
Department of Vascular Surgery,
HSE Midwestern Regional Hospital
, Limerick, Ireland; St John’s Hospital
, Limerick, Ireland
M. Egan
Department of Radiology,
HSE Midwestern Regional Hospital
, Limerick, Ireland
F. Wallis
Department of Radiology,
HSE Midwestern Regional Hospital
, Limerick, Ireland
M. T. Walsh
Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical and Aeronautical Engineering, and the Materials and Surface Science Institute,
University of Limerick
, Limerick, Irelande-mail: michael.walsh@ul.ie
J Biomech Eng. Feb 2011, 133(2): 021003 (9 pages)
Published Online: January 24, 2011
Article history
Received:
October 1, 2009
Revised:
December 20, 2010
Posted:
January 3, 2011
Published:
January 24, 2011
Online:
January 24, 2011
Citation
Carroll, G. T., McGloughlin, T. M., Burke, P. E., Egan, M., Wallis, F., and Walsh, M. T. (January 24, 2011). "Wall Shear Stresses Remain Elevated in Mature Arteriovenous Fistulas: A Case Study." ASME. J Biomech Eng. February 2011; 133(2): 021003. https://doi.org/10.1115/1.4003310
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