Vascular accesses (VA) for hemodialysis are usually created by native arteriovenous fistulas (AVF) or synthetic grafts. Maintaining patency of VA continues to be a major problem for patients with end-stage renal disease, since in these vessels thrombosis and intimal hyperplasia often occur. These lesions are frequently associated with disturbed flow that develops near bifurcations or sharp curvatures. We explored the possibility of investigating blood flow dynamics in a patient-specific model of end-to-end native AVF using computational fluid dynamics (CFD). Using digital subtraction angiographies of an AVF, we generated a three-dimensional meshwork for numerical analysis of blood flow. As input condition, a time-dependent blood waveform in the radial artery was derived from centerline velocity obtained during echo-color-Doppler ultrasound examination. The finite element solution was calculated using a fluid-dynamic software package. In the straight, afferent side of the radial artery wall shear stress ranged between 20 and 36 dynes/cm2, while on the inner surface of the bending zone it increased up to 350 dynes/cm2. On the venous side, proximal to the anastomosis, wall shear stress was oscillating between negative and positive values (from −12 dynes/cm2 to 112 dynes/cm2), while distal from the anastomosis, the wall shear stress returned within the physiologic range, ranging from 8 to 22 dynes/cm2. Areas of the vessel wall with very high shear stress gradient were identified on the bending zone of the radial artery and on the venous side, after the arteriovenous shunt. Secondary blood flows were also observed in these regions. CFD gave a detailed description of blood flow field and showed that this approach can be used for patient-specific analysis of blood vessels, to understand better the role of local hemodynamic conditions in the development of vascular lesions.
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June 2001
Technical Papers
Computational Fluid Dynamics of a Vascular Access Case for Hemodialysis
Bogdan Ene-Iordache,
Bogdan Ene-Iordache
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
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Lidia Mosconi,
Lidia Mosconi
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
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Giuseppe Remuzzi,
Giuseppe Remuzzi
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
Nephrology and Dialysis Unit, Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy
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Andrea Remuzzi
Andrea Remuzzi
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
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Bogdan Ene-Iordache
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
Lidia Mosconi
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
Giuseppe Remuzzi
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
Nephrology and Dialysis Unit, Azienda Ospedaliera Ospedali Riuniti di Bergamo, Bergamo, Italy
Andrea Remuzzi
Clinical Research Center for Rare Diseases Aldo e Cele Dacco`, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica (BG), Italy
Contributed by the Bioengineering Division for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received by the Bioengineering Division November 30, 1999; revised manuscript received December 13, 2000. Associate Editor: C. R. Ethier.
J Biomech Eng. Jun 2001, 123(3): 284-292 (9 pages)
Published Online: December 13, 2000
Article history
Received:
November 30, 1999
Revised:
December 13, 2000
Citation
Ene-Iordache , B., Mosconi, L., Remuzzi, G., and Remuzzi, A. (December 13, 2000). "Computational Fluid Dynamics of a Vascular Access Case for Hemodialysis ." ASME. J Biomech Eng. June 2001; 123(3): 284–292. https://doi.org/10.1115/1.1372702
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