The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography
學年 108
學期 2
出版（發表）日期 2020-07-23
作品名稱 The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography
作品名稱（其他語言）
著者 Chih-Yu Yang; Ming-Chia Li; Chien-Wen Lan; Wang-Jiun Lee; Chen-Ju Lee; Cheng-Hsueh Wu; Jing-Min Tang; Yang-Yao Niu; Yao-Ping Lin; Yan-Ting Shiu; Alfred K. Cheung; Yan-Hwa Wu Lee; Oscar Kuang-Sheng Lee; Shu Chien and Der-Cherng Tarng
單位
出版者
著錄名稱、卷期、頁數 frontiers in Bioengineering and Biotechnology 8, p.846
摘要 The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations using standardized AVF geometry, not the real-world patient images. The present study is the first CFD study to use angiographic images with patient-specific outcome information, i.e., the exact location of the AVF stenotic lesion. We conducted the CFD analysis utilizing patient-specific AVF geometric models to investigate hemodynamic parameters at different locations of an AVF, and the association between hemodynamic parameters and the anastomotic angle, particularly at the stenotic location. We analyzed 27 patients who used radio-cephalic AVF for hemodialysis and received an angiographic examination for juxta-anastomotic stenosis. The three-dimensional geometrical model of each patient’s AVF was built using the angiographic images, in which the shape and the anastomotic angle of the AVF were depicted. CFD simulations of AVF hemodynamics were conducted to obtain blood flow parameters at different locations of an AVF. We found that at the location of the stenotic lesion, the AV angle was significantly correlated with access flow disturbance (r = 0.739; p < 0.001) and flow velocity (r = 0.563; p = 0.002). Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that the AV angle determines the lesion’s flow disturbance with a high area under the curve value of 0.878. The ROC analysis also identified a cut-off value of the AV angle as 46.5°, above or below which the access flow disturbance was significantly different. By applying CFD analysis to real-world patient images, the present study provides evidence that an anastomotic angle wider than 46.5° might lead to disturbed flow generation, demonstrating a reference angle to adopt during the anastomosis surgery.
關鍵字 arteriovenous fistula;angiography;anastomotic angle;stenosis;computational fluid dynamics;disturbed flow
語言 en_US
ISSN 2296-4185
期刊性質 國內
收錄於
產學合作
通訊作者
審稿制度 是
國別 USA
公開徵稿
出版型式 ,電子版
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