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Research Papers

High-Resolution Computational Fluid Dynamic Simulation of Haemodialysis Cannulation in a Patient-Specific Arteriovenous Fistula

[+] Author and Article Information
David Fulker

School of Mechanical and
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: dave_fulker@hotmail.com

Bogdan Ene-Iordache

Department of Biomedical Engineering,
IRCCS—Istituto di Ricerche
Farmacologiche “Mario Negri,”
Ranica, BG 24020, Italy
e-mail: Bogdan.ene-iordache@marionegri.it

Tracie Barber

School of Mechanical and
Manufacturing Engineering,
University of New South Wales,
Ainsworth Building,
Kensington Campus,
Kensington, NSW 2025, Australia
e-mail: t.barber@unsw.edu.au

Manuscript received April 19, 2017; final manuscript received October 18, 2017; published online January 19, 2018. Assoc. Editor: Keefe B. Manning.

J Biomech Eng 140(3), 031011 (Jan 19, 2018) (8 pages) Paper No: BIO-17-1162; doi: 10.1115/1.4038289 History: Received April 19, 2017; Revised October 18, 2017

Arteriovenous fistulae (AVF) are the preferred choice of vascular access in hemodialysis patients; however, complications such as stenosis can lead to access failure or recirculation, which reduces dialysis efficiency. This study utilized computational fluid dynamics on a patient-specific radiocephalic fistula under hemodialysis treatment to determine the dynamics of access recirculation and identify the presence of disturbed flow. Metrics of transverse wall shear stress (transWSS) and oscillatory shear index (OSI) were used to characterize the disturbed flow acting on the blood vessel wall, while a power spectral density (PSD) analysis was used to calculate the any turbulence within the access. Results showed that turbulence is generated at the anastomosis and continues through the swing segment. The arterial needle dampens the flow as blood is extracted to the dialyzer, while the venous needle reintroduces turbulence due to the presence of jet flows. Adverse shear stresses are present throughout the vascular access and coincide with these complex flow fields. The position of the needles had no effect in minimizing these forces. However, improved blood extraction may occur when the arterial needle is placed further from the anastomosis, minimizing the effects of residual turbulent structures generated at the anastomosis. Furthermore, the arterial and venous needle may be placed in close proximity to each other without increasing the risk of access recirculation, in a healthy mature fistula, due to the relatively stable blood flow in this region. This may negate the need for a long cannulation segment and aid clinicians in optimizing needle placement for hemodialysis.

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Figures

Grahic Jump Location
Fig. 1

Velocity monitor point locations for power spectral density analysis: (i) at the anastomosis, (ii) in the swing segment, (iii) in between the arterial and venous needle, (iv) downstream of the venous needle, and (v) in the venous outflow

Grahic Jump Location
Fig. 2

Flow phenotype visualized using isosurfaces of Q-criterion. Systole in the left column, diastole in the right column. (a) Arterial needle placed 3 cm from the anastomosis, (b) arterial needle placed 4 cm from the anastomosis, and (c) arterial needle placed 5 cm from the anastomosis.

Grahic Jump Location
Fig. 3

Power spectral density analysis of the flow velocity in the vascular access normalized by the average velocity: (a) at the anastomosis, (b) in the swing segment, (c) in between the arterial and venous needle, (d) downstream of the venous needle, and (e) in the venous outflow. For online version (Blue—arterial needle placed 3 cm from the anastomosis. Green—arterial needle placed 4 cm from the anastomosis. Red—arterial needle placed 5 cm from the anastomosis).

Grahic Jump Location
Fig. 4

OSI on the blood vessel wall of the vascular access. Left column reveals the top side of the vessel; right column reveals the underside of the vessel: (a) arterial needle placed 3 cm from the anastomosis, (b) arterial needle placed 4 cm from the anastomosis, and (c) arterial needle placed 5 cm from the anastomosis.

Grahic Jump Location
Fig. 5

TransWSS on the blood vessel wall of the vascular access normalized by the average WSS (Pa). Left column reveals the top side of the vessel; right column reveals the underside of the vessel: (a) arterial needle placed 3 cm from the anastomosis, (b) arterial needle placed 4 cm from the anastomosis, and (c) arterial needle placed 5 cm from the anastomosis.

Grahic Jump Location
Fig. 6

Flow phenotype visualized using isosurfaces of Q-criterion. Systole in the left column, diastole in the right column: (a) venous needle placed 1 cm from the arterial needle, (b) venous needle placed 2 cm from the arterial needle, and (c)venous needle placed 3 cm from the arterial needle.

Grahic Jump Location
Fig. 7

PSD analysis of the flow velocity in the vascular access normalized by the average velocity: (a) at the anastomosis, (b) in the swing segment, (c) in between the arterial and venous needle, (d) downstream of the venous needle, and (e) in the venous outflow. For online version (Blue—venous needle placed 1 cm from the arterial needle. Green—venous needle placed 2 cm from the arterial needle. Red—venous needle placed 3 cm from the arterial needle).

Grahic Jump Location
Fig. 8

OSI on the blood vessel wall of the vascular access: (a) venous needle placed 1 cm from the arterial needle, (b) venous needle placed 2 cm from the arterial needle, and (c) venous needle placed 3 cm from the arterial needle

Grahic Jump Location
Fig. 9

TransWSS on the blood vessel wall of the vascular access normalized by the average WSS (Pa). Left column reveals the top side of the vessel, right column reveals the underside of the vessel: (a) venous needle placed 1 cm from the arterial needle, (b) venous needle placed 2 cm from the arterial needle, and (c) venous needle placed 3 cm from the arterial needle.

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