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Hemodynamics in the cephalic arch of a brachiocephalic fistula

机译：臂头瘘瘘头弓的血流动力学

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摘要

The care and outcome of patients with end stage renal disease (ESRD) on chronic hemodialysis is directly dependent on their hemodialysis access. A brachiocephalic fistula (BCF) is commonly placed in the elderly and in patients with a failed lower-arm, or radiocephalic, fistula. However, there are numerous complications such that the BCF has an average patency of only 3.6 years. A leading cause of BCF dysfunction and failure is stenosis in the arch of the cephalic vein near its junction with the axillary vein, which is called cephalic arch stenosis (CAS). Using a combined clinical and computational investigation, we seek to improve our understanding of the cause of CAS, and to develop a means of predicting CAS risk in patients with a planned BCF access. This paper details the methodology used to determine the hemodynamic consequences of the post-fistula environment and illustrates detailed results for a representative sample of patient-specific anatomies, including a single, bifurcated, and trifurcated arch. It is found that the high flows present due to fistula creation lead to secondary flows in the arch owing to its curvature with corresponding low wall shear stresses. The abnormally low wall shear stress locations correlate with the development of stenosis in the singular case that is tracked in time for a period of one year.
机译：患有终末期肾病（ESRD）的慢性血液透析患者的护理和结果直接取决于他们的血液透析途径。头臂瘘（BCF）通常放置在老年人和下臂或放射头瘘失败的患者中。但是，存在许多并发症，因此BCF的平均通畅时间仅为3.6年。 BCF功能障碍和衰竭的主要原因是与腋静脉连接处附近的头静脉弓狭窄，这被称为头弓狭窄（CAS）。通过结合临床和计算研究，我们寻求加深对CAS病因的了解，并开发一种预测计划BCF通路患者CAS风险的方法。本文详细介绍了用于确定瘘管后环境的血液动力学后果的方法，并举例说明了患者特定解剖结构（包括单个，分叉和三叉弓）的代表性样本的详细结果。发现由于瘘管的形成而存在的高流量由于其曲率和相应的低壁剪切应力而导致了弓形中的二次流量。异常低的壁切应力位置与单例情况下的狭窄发展相关，该情况在一年的时间内被及时跟踪。

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