Variation of flow rate and angle of injected venous needle on influencing intimal hyperplasia at the venous anastomosis of the hemodialysis graft
Variation of flow rate and angle of injected venous needle on influencing intimal hyperplasia at the venous anastomosis of the hemodialysis graft
复制标题
血液透析移植物静脉吻合时注射静脉针流量和角度变化对内膜增生的影响
DOI：
10.1007/s13246-017-0526-6
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发表时间：
2017-03-01
影响因子：
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通讯作者：
Liu, Wanqian
中科院分区：
文献类型：
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作者：
Yang, Linqiang;Yin, Aijun;Liu, Wanqian
在血液透析过程中，动静脉（AV）移植物容易导致静脉吻合处内膜增生（IH），从而导致移植物失败。有充分的证据表明，血液动力学因素与IH有关，以及移植物狭窄的发病机制。本文研究静脉针注射流速和注射角度对血液透析移植物损伤的影响。这种损伤主要是由血流动力学引起的，而不是针的实际物理穿刺。通过对AV接枝流动的计算流体动力学分析，我们证明了较慢的流动速度可以保持较大的低壁剪切应力（WSS）区域。大的针流角和快的流速容易引起血液对移植物壁的高剪切，从而形成高WSS的集中区。尽管如此，流速的增加对壁面剪应力梯度的影响比流动角的变化更显著。显然，优化注射速度很重要，因为高角度可以减小注射穿刺的尺寸，减少对血管壁的损伤；但是较慢的注射速度可能会延迟血液透析。因此，本研究寻求理想的针头角度和流量。
During hemodialysis, arteriovenous (AV) grafts tends to result in intimal hyperplasia (IH) at the venous anastomosis which leads to graft failure. It is well documented that hemodynamic factors have been implicated in IH, as well as pathogenesis of graft stenosis. In this paper, we investigate the flow rate and angle of injection of a venous needle on damaging the hemodialysis graft. Such damage is mainly caused by hemodynamics rather than the actual physical puncture of the needle. By computational fluid dynamic analysis of flow through the AV grafts, we demonstrate that slower flow rate of the needle preserve a larger region of low wall shear stress (WSS). High needle flow angle and fast flow rate tends to induce high shearing of blood against the graft wall, and therefore resulting in a concentrated region of high WSS. Despite that, the increased flow rate causes more significant change to wall shear stress gradient than the flow angle. Obviously, it is important to optimize the injection rate since a high angle can reduce the size of the injection puncture and have smaller injury for the vessel walls; but a slower injection rate may delay hemodialysis. Therefore, the ideal angle and flow rate of needle is sought in this study.