Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields.
Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields.
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DOI：
10.1038/s41598-021-90813-3
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发表时间：
2021-06-09
影响因子：
4.6
通讯作者：
Zayed M
中科院分区：
文献类型：
--
作者：
Williams D;Leuthardt EC;Genin GM;Zayed M
动脉-静脉移植物通常用于终末期肾病患者的血液透析。这些移植物是高压动脉和低压静脉之间的管道。移植物静脉端的连接，称为移植物-静脉吻合术，由于狭窄和血栓形成的高发生率而经常和长期失败。这些失效被广泛认为与移植物-静脉吻合处的病理性高和低流动剪切应变率有关。我们假设，与管道流动动力学和先前研究动静脉瘘中静脉-动脉吻合角度的工作一致，改变移植物-静脉吻合角度可以降低病理性剪切率场的发生率。我们通过计算流体动力学模拟的理想化动静脉移植物，使用Bird-Carreau本构关系的血液。我们观察到，低移植物-静脉吻合角（）导致病理性低剪切率的发生率增加，而高移植物-静脉吻合角（）导致病理性高剪切率的发生率增加。优化预测，中间（）移植物-吻合角度最佳。我们的研究表明，移植物-静脉吻合角度可以显著影响病理流场，并且可以优化以显著提高动静脉移植物通畅率。
Arteriovenous grafts are routinely placed to facilitate hemodialysis in patients with end stage renal disease. These grafts are conduits between higher pressure arteries and lower pressure veins. The connection on the vein end of the graft, known as the graft-to-vein anastomosis, fails frequently and chronically due to high rates of stenosis and thrombosis. These failures are widely believed to be associated with pathologically high and low flow shear strain rates at the graft-to-vein anastomosis. We hypothesized that consistent with pipe flow dynamics and prior work exploring vein-to-artery anastomosis angles in arteriovenous fistulas, altering the graft-to-vein anastomosis angle can reduce the incidence of pathological shear rate fields. We tested this via computational fluid dynamic simulations of idealized arteriovenous grafts, using the Bird-Carreau constitutive law for blood. We observed that low graft-to-vein anastomosis angles () led to increased incidence of pathologically low shear rates, and that high graft-to-vein anastomosis angles () led to increased incidence of pathologically high shear rates. Optimizations predicted that an intermediate () graft-to-anastomosis angle was optimal. Our study demonstrates that graft-to-vein anastomosis angles can significantly impact pathological flow fields, and can be optimized to substantially improve arteriovenous graft patency rates.
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影响因子：
158.5
作者：
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通讯作者：
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