Arteriovenous fistulae (AVF) are the preferred choice of vascular access in hemodialysis patients; however, complications such as stenosis can lead to access failure or recirculation, which reduces dialysis efficiency. This study utilized computational fluid dynamics on a patient-specific radiocephalic fistula under hemodialysis treatment to determine the dynamics of access recirculation and identify the presence of disturbed flow. Metrics of transverse wall shear stress (transWSS) and oscillatory shear index (OSI) were used to characterize the disturbed flow acting on the blood vessel wall, while a power spectral density (PSD) analysis was used to calculate the any turbulence within the access. Results showed that turbulence is generated at the anastomosis and continues through the swing segment. The arterial needle dampens the flow as blood is extracted to the dialyzer, while the venous needle reintroduces turbulence due to the presence of jet flows. Adverse shear stresses are present throughout the vascular access and coincide with these complex flow fields. The position of the needles had no effect in minimizing these forces. However, improved blood extraction may occur when the arterial needle is placed further from the anastomosis, minimizing the effects of residual turbulent structures generated at the anastomosis. Furthermore, the arterial and venous needle may be placed in close proximity to each other without increasing the risk of access recirculation, in a healthy mature fistula, due to the relatively stable blood flow in this region. This may negate the need for a long cannulation segment and aid clinicians in optimizing needle placement for hemodialysis.
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March 2018
Research-Article
High-Resolution Computational Fluid Dynamic Simulation of Haemodialysis Cannulation in a Patient-Specific Arteriovenous Fistula
David Fulker,
David Fulker
School of Mechanical and
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: dave_fulker@hotmail.com
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: dave_fulker@hotmail.com
Search for other works by this author on:
Bogdan Ene-Iordache,
Bogdan Ene-Iordache
Department of Biomedical Engineering,
IRCCS—Istituto di Ricerche
Farmacologiche “Mario Negri,”
Ranica, BG 24020, Italy
e-mail: Bogdan.ene-iordache@marionegri.it
IRCCS—Istituto di Ricerche
Farmacologiche “Mario Negri,”
Ranica, BG 24020, Italy
e-mail: Bogdan.ene-iordache@marionegri.it
Search for other works by this author on:
Tracie Barber
Tracie Barber
School of Mechanical and
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: t.barber@unsw.edu.au
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: t.barber@unsw.edu.au
Search for other works by this author on:
David Fulker
School of Mechanical and
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: dave_fulker@hotmail.com
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: dave_fulker@hotmail.com
Bogdan Ene-Iordache
Department of Biomedical Engineering,
IRCCS—Istituto di Ricerche
Farmacologiche “Mario Negri,”
Ranica, BG 24020, Italy
e-mail: Bogdan.ene-iordache@marionegri.it
IRCCS—Istituto di Ricerche
Farmacologiche “Mario Negri,”
Ranica, BG 24020, Italy
e-mail: Bogdan.ene-iordache@marionegri.it
Tracie Barber
School of Mechanical and
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: t.barber@unsw.edu.au
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: t.barber@unsw.edu.au
Manuscript received April 19, 2017; final manuscript received October 18, 2017; published online January 19, 2018. Assoc. Editor: Keefe B. Manning.
J Biomech Eng. Mar 2018, 140(3): 031011 (8 pages)
Published Online: January 19, 2018
Article history
Received:
April 19, 2017
Revised:
October 18, 2017
Citation
Fulker, D., Ene-Iordache, B., and Barber, T. (January 19, 2018). "High-Resolution Computational Fluid Dynamic Simulation of Haemodialysis Cannulation in a Patient-Specific Arteriovenous Fistula." ASME. J Biomech Eng. March 2018; 140(3): 031011. https://doi.org/10.1115/1.4038289
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