Hemodynamics in AVF over time: A protective role of vascular remodeling toward flow stabilization.

IF 1.4 4区 医学 Q4 ENGINEERING, BIOMEDICAL
Luca Soliveri, Michela Bozzetto, Paolo Brambilla, Anna Caroli, Andrea Remuzzi
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引用次数: 1

Abstract

The mechanisms underlying vascular stenosis formation in the arteriovenous fistula (AVF) for hemodialysis (HD) remain mostly unknown. Several computational fluid dynamics (CFD) studies have suggested a potential role for unsteady flow in inducing intimal hyperplasia and AVF stenosis, but the majority of these observations have been limited to a single time point after surgical creation. The aim of the present study was to investigate the relation between hemodynamic conditions and AVF vascular remodeling through a CFD longitudinal study. Non contrast-enhanced MR images and Doppler Ultrasound (US) examinations were acquired at 3 days, 40 days, 6 months, 1 year, and 1.5 years after surgery in a 72-year male referred for native radio-cephalic AVF. Three-dimensional AVF models were generated and high fidelity CFD simulations were performed using pimpleFoam, setting patient-specific boundary conditions derived from US. Morphological and hemodynamic changes over time were then analyzed. Analysis of vessel morphology and hemodynamics during follow-up showed that the AVF had a successful maturation process, characterized by a massive arterial and venous dilatation within the 6 months after surgery, a corresponding increase in blood flow volume and important flow instabilities. Between 6 months and 1 year, a stenosis developed in the juxta-anastomotic vein and caused AVF failure at 1.5 years. The development of stenosis was paralleled by the regularization of blood flow velocity pattern and consequent decrease in the near-wall disturbed flow metrics. These results suggest that development of intimal hyperplasia and vessel stenosis, triggered by unsteady flow, could be the result of vascular inward remodeling toward regularization of turbulent-like flow.

Abstract Image

Abstract Image

Abstract Image

AVF随时间变化的血流动力学:血管重塑对血流稳定的保护作用。
血液透析(HD)动静脉瘘(AVF)血管狭窄形成的机制大多未知。几项计算流体力学(CFD)研究表明,不稳定流动在诱导内膜增生和AVF狭窄中具有潜在作用,但这些观察结果大多局限于手术后的单个时间点。本研究的目的是通过CFD纵向研究来研究血液动力学条件与AVF血管重塑之间的关系。第3天采集非增强MR图像和多普勒超声(US)检查 天,40 天,6 月,1 年和1.5 一名72岁男性因先天性放射性脑动静脉畸形手术后数年。生成三维AVF模型,并使用丘疹泡沫进行高保真CFD模拟,设置源自US的患者特定边界条件。然后分析随时间变化的形态学和血液动力学。随访期间对血管形态和血流动力学的分析表明,AVF有一个成功的成熟过程,其特征是6 术后数月,血流量相应增加,血流不稳定。介于6 月和1 年,吻合口旁静脉出现狭窄,导致1.5岁时AVF衰竭 年。狭窄的发展与血流速度模式的规则化以及随之而来的近壁干扰血流指标的降低相平行。这些结果表明,由不稳定流动引发的内膜增生和血管狭窄的发展可能是血管向内重塑向湍流样流规则化的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Journal of Artificial Organs
International Journal of Artificial Organs 医学-工程:生物医学
CiteScore
3.40
自引率
5.90%
发文量
92
审稿时长
3 months
期刊介绍: The International Journal of Artificial Organs (IJAO) publishes peer-reviewed research and clinical, experimental and theoretical, contributions to the field of artificial, bioartificial and tissue-engineered organs. The mission of the IJAO is to foster the development and optimization of artificial, bioartificial and tissue-engineered organs, for implantation or use in procedures, to treat functional deficits of all human tissues and organs.
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