Arteriovenous fistulae are surgically created to provide adequate access for dialysis patients suffering from end-stage renal disease. It has long been hypothesized that the rapid blood vessel remodeling occurring after fistula creation is, in part, a process to restore the mechanical stresses to some preferred level, i.e., mechanical homeostasis. We present computational hemodynamic simulations in four patient-specific models of mature arteriovenous fistulae reconstructed from 3D ultrasound scans. Our results suggest that these mature fistulae have remodeled to return to ‘‘normal’’ shear stresses away from the anastomoses: about 1.0 Pa in the outflow veins and about 2.5 Pa in the inflow arteries. Large parts of the anastomoses were found to be under very high shear stresses Pa, over most of the cardiac cycle. These results suggest that the remodeling process works toward restoring mechanical homeostasis in the fistulae, but that the process is limited or incomplete, even in mature fistulae, as evidenced by the elevated shear at or near the anastomoses. Based on the long term clinical viability of these dialysis accesses, we hypothesize that the elevated nonhomeostatic shear stresses in some portions of the vessels were not detrimental to fistula patency.
Incomplete Restoration of Homeostatic Shear Stress Within Arteriovenous Fistulae
Applied Physics Laboratory,
Center for Industrial and Medical Ultrasound,
Department of Surgery,
Division of Vascular Surgery,
Contributed by the Bioengineering Division of ASME for publication in the Journal of Biomechanical Engineering. Manuscript received April 18, 2012; final manuscript received November 7, 2012; accepted manuscript posted December 8, 2012; published online December 27, 2012. Assoc. Editor: Fotis Sotiropoulos.
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McGah, P. M., Leotta, D. F., Beach, K. W., Eugene Zierler, R., and Aliseda, A. (December 27, 2012). "Incomplete Restoration of Homeostatic Shear Stress Within Arteriovenous Fistulae." ASME. J Biomech Eng. January 2013; 135(1): 011005. https://doi.org/10.1115/1.4023133
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