Evaluation of the hemodynamics in straight 6-mm and tapered 6- to 8-mm grafts as upper arm hemodialysis vascular access
Evaluation of the hemodynamics in straight 6-mm and tapered 6- to 8-mm grafts as upper arm hemodialysis vascular access
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作为上臂血液透析血管通路的直 6 毫米和锥形 6 至 8 毫米移植物的血流动力学评估
DOI：
10.1007/s11517-014-1181-7
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发表时间：
2014
影响因子：
3.2
通讯作者：
E. Samiei
中科院分区：
文献类型：
--
作者：
M. Sarmast;H. Niroomand;F. Ghalichi;E. Samiei
本研究旨在研究和比较两种不同尺寸的血液透析动静脉移植物用于上臂血液透析血管通路的血流动力学：动脉侧8 mm锥形至6 mm和直形6 mm。本文提出了一种计算模拟方法，并与文献中的实验和数值压力测量结果进行了对比验证。在模型的动脉入口和静脉出口边界处施加的边界条件分别是生理速度和压力波形。血流场和血流动力学指标的分布模式，包括壁面切应力（WSS）作为心血管系统的主要血流动力学参数之一和空间壁面切应力梯度（SWSSG）作为扰动的流动模式的指标，因此病变发展的敏感部位之间的分析和比较两种移植物。锥形6- 8-mm移植物似乎与静脉吻合（VA）和下游静脉内干扰较少的流动模式相关，同时受益于内部较高的血液流速。此外，它在VA周围和整个静脉下游的WSS和SWSSG分布模式方面显示出明确的优势，其值显著较低，从而降低了血栓形成和狭窄病变发展的风险。使用6- 8 mm锥形移植物的唯一缺点是动脉交界处的血流动力学参数值较高，这是由于其平均血流速度明显较高。结果清楚地表明，作为上臂血液透析血管通路移植物，锥形6- 8 mm移植物的血流动力学性能完全优于直型6 mm移植物，并证实了文献中的临床数据，这建议有利地使用锥形的6-至8-在选定的患者组中，使用mm移植物创建上臂臂腋血液透析血管通路移植物，并发症
The present study is intended to investigate and compare the hemodynamics in two different sizes of hemodialysis arteriovenous grafts for upper arm hemodialysis vascular access: 8-mm tapered to 6-mm at the arterial side and straight 6 mm. A computational simulation approach is presented for this study, which is validated against the available experimental and numerical pressure measurements in the literature. The imposed boundary conditions at the arterial inlet and venous outlet boundaries of the models are physiological velocity and pressure waveforms, respectively. Blood flow fields and distribution patterns of the hemodynamic indices including wall shear stress (WSS) as one of the major hemodynamic parameters of the cardiovascular system and spatial wall shear stress gradient (SWSSG) as an indicator of disturbed flow patterns and hence susceptible sites of lesion developments are analyzed and compared between the two grafts. The tapered 6- to 8-mm graft seemingly is associated with less disturbed flow patterns within the venous anastomosis (VA) and the vein downstream while benefiting from higher blood flow rates within. Also, it shows a definitive advantage in terms of WSS and SWSSG distribution patterns around the VA and throughout the vein downstream with significantly lower values, which reduce the risk of thrombosis formation and stenotic lesion developments. The only disadvantage encountered in using 6- to 8-mm tapered graft is higher values of hemodynamic parameters at the arterial junction attributable to its significantly higher mean blood flow rate within. The results clearly indicate that the tapered 6- to 8-mm graft entirely outperforms straight 6-mm graft hemodynamically as an upper arm hemodialysis vascular access graft and confirms clinical data in the literature, which suggests advantageous use of tapered 6- to 8-mm grafts in the creation of upper arm brachioaxillary hemodialysis vascular access grafts in selected groups of patients with expectably higher patency rates and lower complications.
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DOI：
10.1161/01.atv.12.11.1254
发表时间：
1992-11-01
期刊：
ARTERIOSCLEROSIS AND THROMBOSIS
影响因子：
--
作者：
DEPAOLA, N;GIMBRONE, MA;DEWEY, CF
通讯作者：
DEWEY, CF
影响因子：
2.4
作者：
Buchanan, JR;Kleinstreuer, C;Truskey, GA
通讯作者：
Truskey, GA
动静脉移植物内流动分配对湍流过渡的重要性。
影响因子：
2.4
作者：
Lee,Sang-Wook;Smith,DavidS;Loth,Francis;Fischer,PaulF;Bassiouny,HishamS
通讯作者：
Bassiouny,HishamS
DOI：
10.1152/ajpheart.00897.2003
发表时间：
2004-05-01
影响因子：
4.8
作者：
Himburg, HA;Grzybowski, DM;Friedman, MH
通讯作者：
Friedman, MH
影响因子：
4.3
作者：
Meyerson, SL;Skelly, CL;Schwartz, LB
通讯作者：
Schwartz, LB