Effect of arteriovenous graft flow rate on vascular access hemodynamics in a novel modular anastomotic valve device

Abstract

Purpose:

Perturbed vascular access hemodynamics is considered a potential driver of intimal hyperplasia, the leading cause of vascular access failure. To improve vascular access patency, a modular anastomotic valve device has been designed to normalize venous flow between hemodialysis periods while providing normal vascular access during hemodialysis. The objective of this study was to quantify the effects of arteriovenous graft flow rate on modular anastomotic valve device vascular access hemodynamics under realistic hemodialysis conditions.

Methods:

Modular anastomotic valve device inlet and outlet flow conditions and velocity profiles were measured by ultrasound Doppler in a vascular access flow loop replicating arteriovenous graft flow rates of 800, 1000, and 1500 mL/min. Fluid–structure interaction simulations were performed to identify low wall shear stress regions on the vein wall and to characterize them in terms of temporal shear magnitude, oscillatory shear index, and relative residence time. The model was validated with respect to the Doppler measurements.

Results:

The low wall shear stress region generated downstream of the anastomosis under low and moderate arteriovenous graft flow rates was eliminated under the highest arteriovenous graft flow rate. Increase in arteriovenous graft flow rate from 800 to 1500 mL/min resulted in a substantial increase in wall shear stress magnitude (27-fold increase in temporal shear magnitude), the elimination of wall shear stress bidirectionality (0.20-point reduction in oscillatory shear index), and a reduction in flow stagnation (98% decrease in relative residence time). While the results suggest the ability of high arteriovenous graft flow rates to protect the venous wall from intimal hyperplasia–prone hemodynamics, they indicate their adverse impact on the degree of venous hemodynamic abnormality.

Keywords

Hemodialysis vascular access arteriovenous graft hemodynamics intimal hyperplasia fluid–structure interaction Doppler ultrasound

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References

Miller

Carlton

Deierhoi

et al . Natural history of arteriovenous grafts in hemodialysis patients. Am J Kidney Dis 2000; 36(1): 68–74.

Schwab

Harrington

Singh

et al . Vascular access for hemodialysis. Kidney Int 1999; 55(5): 2078–2090.

Sho

Nanjo

Sho

et al . Arterial enlargement, tortuosity, and intimal thickening in response to sequential exposure to high and low wall shear stress. J Vasc Surg 2004; 39(3): 601–612.

Kovalik

Schwab

SJ.

Can venous stenosis be prevented?

Semin Dial 2002; 12(3): 144–145.

Schwab

SJ.

Hemodialysis vascular access: the Achilles’ heel remains. Kidney Int 2007; 72(6): 665–666.

Akoh

JA.

Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access 2009; 10(3): 137–147.

Zwolak

Adams

Clowes

AW.

Kinetics of vein graft hyperplasia: association with tangential stress. J Vasc Surg 1987; 5(1): 126–136.

Staalsen

Ulrich

Winther

The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo. J Vasc Surg 1995; 21(3): 460–471.

Jackson

Ishibashi

Effects of anastomotic angle on vascular tissue responses at end-to-side arterial grafts. J Vasc Surg 2001; 34(2): 300–307.

10.

Ojha

Cobbold

Johnston

Influence of angle on wall shear stress distribution for an end-to-side anastomosis. J Vasc Surg 1994; 19(6): 1067–1073.

11.

Haruguchi

Teraoka

Intimal hyperplasia and hemodynamic factors in arterial bypass and arteriovenous grafts: a review. J Artif Organs 2003; 6(4): 227–235.

12.

Sunamura

Ishibashi

Karino

Flow patterns and preferred sites of intimal thickening in diameter-mismatched vein graft interpositions. Surgery 2007; 141(6): 764–776.

13.

Ene-Iordache

Cattaneo

Dubini

et al . Effect of anastomosis angle on the localization of disturbed flow in “side-to-end” fistulae for haemodialysis access. Nephrol Dial Transplant 2013; 28: 997–1005.

14.

McNally

Akingba

Robinson

et al . Novel modular anastomotic valve device for hemodialysis vascular access: preliminary computational hemodynamic assessment. J Vasc Access 2014; 15(6): 448–460.

15.

Owens

CD.

Adaptive changes in autogenous vein grafts for arterial reconstruction: clinical implications. J Vasc Surg 2010; 51(3): 736–746.

16.

Giddens

Zarins

et al . Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis 1985; 5(3): 293–302.

17.

Van Tricht

De Wachter

Tordoir

et al . Experimental analysis of the hemodynamics in punctured vascular access grafts. ASAIO J 2005; 51(4): 352–359.

18.

Malovrh

5th European basic multidisciplinary hemodialysis access course. Blood Purificat 2002; 20: 409–440.

19.

McNally

Madan

Sucosky

Morphotype-dependent flow characteristics in bicuspid aortic valve ascending aortas: a benchtop particle image velocimetry study. Front Physiol 2017; 8: 44.

20.

Seaman

McNally

Biddle

et al . Generation of simulated calcific lesions in valve leaflets for flow studies. J Heart Valve Dis 2015; 24(1): 115–125.

21.

Seaman

Akingba

AAG

Sucosky

Steady flow hemodynamic and energy loss measurements in normal and simulated calcified tricuspid and bicuspid aortic valves. J Biomech Eng 2014; 136(4): 1–11.

22.

Langtry

Menter

. Transition modeling for general CFD applications in aeronautics. In: 43rd AIAA aerospace sciences meeting and exhibit, Reno, NV, 10–13 January 2005. Reston, VA: American Institute of Aeronautics and Astronautics.

23.

Tan

FPP

Soloperto

Wood

et al . Advanced computational models for disturbed and turbulent flow in stenosed human carotid artery bifurcation. In: 4th Kuala Lumpur international conference on biomedical engineering, Kuala Lumpur, Malaysia, 25–28 June 2008, pp. 390–394. Berlin: Springer.

24.

Rezakhaniha

Stergiopulos

A structural model of the venous wall considering elastin anisotropy. J Biomech Eng 2008; 130(3): 031017.

25.

Cao

Bukač

Sucosky

Three-dimensional macro-scale assessment of regional and temporal wall shear stress characteristics on aortic valve leaflets. Comput Methods Biomech Biomed Engin 2016; 19(6): 603–613.

26.

Cao

Sucosky

Effect of bicuspid aortic valve cusp fusion on aorta wall shear stress: preliminary computational assessment and implication for aortic dilation. World J Cardiovasc Dis 2015; 5(6): 129–140.

27.

Cao

Sucosky

Computational comparison of regional stress and deformation characteristics in tricuspid and bicuspid aortic valve leaflets. Int J Numer Method Biomed Eng 2017; 33(3): e02798.

28.

Cao

Atkins

McNally

et al . Simulations of morphotype-dependent hemodynamics in non-dilated bicuspid aortic valve aortas. J Biomech 2017; 1150: 63–70.

29.

Mahadevia

Barker

Schnell

et al . Bicuspid aortic cusp fusion morphology alters aortic 3D outflow patterns, wall shear stress and expression of aortopathy. Circulation 2014; 129: 673–682.

30.

Sigovan

Hope

Dyverfeldt

et al . Comparison of four-dimensional flow parameters for quantification of flow eccentricity in the ascending aorta. J Magn Reson Imaging 2011; 34(5): 1226–1230.

31.

Ene-Iordache

Remuzzi

Disturbed flow in radial-cephalic arteriovenous fistulae for haemodialysis: low and oscillating shear stress locates the sites of stenosis. Nephrol Dial Transplant 2012; 27(1): 358–368.

32.

Sarmast

Niroomand-Oscuii

Ghalichi

et al . Evaluation of the hemodynamics in straight 6-mm and tapered 6- to 8-mm grafts as upper arm hemodialysis vascular access. Med Biol Eng Comput 2014; 52(9): 797–811.

33.

Lee

Fischer

Loth

et al . Flow-induced vein-wall vibration in an arteriovenous graft. J Fluids Struct 2005; 20(6): 837–852.

34.

Van Canneyt

Morbiducci

Eloot

et al . A computational exploration of helical arterio-venous graft designs. J Biomech 2013; 46(2): 345–353.

35.

Van Tricht

De Wachter

Tordoir

et al . Comparison of the hemodynamics in 6mm and 4–7 mm hemodialysis grafts by means of CFD. J Biomech 2006; 39(2): 226–236.