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首页> 外文期刊>Cardiovascular engineering and technology >The Effect of Arterial Curvature on Blood Flow in Arterio-Venous Fistulae: Realistic Geometries and Pulsatile Flow
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The Effect of Arterial Curvature on Blood Flow in Arterio-Venous Fistulae: Realistic Geometries and Pulsatile Flow

机译：动脉曲率对动脉静脉瘘血流的影响：现实几何形状和脉动流动

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Arterio-Venous Fistulae (AVF) are regarded as the "gold standard" method of vascular access for patients with End-Stage Renal Disease (ESRD) who require haemodialysis. However, up to 60% of AVF do not mature, and hence fail, as a result of Intimal Hyperplasia (IH). Unphysiological flow and oxygen transport patterns, associated with the unnatural and often complex geometries of AVF, are believed to be implicated in the development of IH. Previous studies have investigated the effect of arterial curvature on blood flow in AVF using idealized planar AVF configurations and non-pulsatile inflow conditions. The present study takes an important step forwards by extending this work to more realistic non-planar brachiocephalic AVF configurations with pulsatile inflow conditions. Results show that forming an AVF by connecting a vein onto the outer curvature of an arterial bend does not, necessarily, suppress unsteady flow in the artery. This finding is converse to results from a previous more idealized study. However, results also show that forming an AVF by connecting a vein onto the inner curvature of an arterial bend can suppress exposure to regions of low wall shear stress and hypoxia in the artery. This finding is in agreement with results from a previous more idealized study. Finally, results show that forming an AVF by connecting a vein onto the inner curvature of an arterial bend can significantly reduce exposure to high WSS in the vein. The results are important, as they demonstrate that in realistic scenarios arterial curvature can be leveraged to reduce exposure to excessively low/high levels of WSS and regions of hypoxia in AVF. This may in turn reduce rates of IH and hence AVF failure.
机译：动脉静脉瘘（AVF）被视为血管进入的“黄金标准”方法，患者患有血液透析的末期肾病（ESRD）。然而，由于内膜增生（IH），高达60％的AVF不成熟，因此失败了。与AVF的不自然和通常复杂的几何形状相关的无生物流动和氧气传输模式被认为是牵引IH的发展。先前的研究通过理想的平面AVF配置和非脉动流入条件研究了动脉曲率对AVF血流的影响。本研究通过将这项工作延伸到更现实的非平面叉子骨骼AVF配置，通过脉动流入条件进行了重要的一步。结果表明，通过将静脉连接到动脉弯曲的外曲率上，形成AVF不一定地抑制动脉中的不稳定流动。这一发现与先前的更理想化的研究结果相反。然而，结果还表明，通过将静脉连接到动脉弯曲的内曲率上，形成AVF可以抑制暴露于导动中低壁剪切应力和缺氧的区域。这一发现与前一个理想化的研究的结果一致。最后，结果表明，通过将静脉连接到动脉弯曲的内曲率上，形成AVF可以显着减少静脉中的高WSS暴露。结果很重要，因为他们表明，在现实的情景中，可以利用动脉曲率，以减少暴露于过低/高水平的AVF中缺氧的区域。这可能反过来减少IH的速率，因此可以失败。

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