Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields

Abstract 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 freq...

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Autores principales:	Dillon Williams, Eric C. Leuthardt, Guy M. Genin, Mohamed Zayed
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7feefee451564b1985c4b81cfab48d92
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spelling	oai:doaj.org-article:7feefee451564b1985c4b81cfab48d922021-12-02T14:58:25ZTailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields10.1038/s41598-021-90813-32045-2322https://doaj.org/article/7feefee451564b1985c4b81cfab48d922021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90813-3https://doaj.org/toc/2045-2322Abstract 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 ( $$<20^{\circ }$$ < 20 ∘ ) led to increased incidence of pathologically low shear rates, and that high graft-to-vein anastomosis angles ( $$>40^{\circ }$$ > 40 ∘ ) led to increased incidence of pathologically high shear rates. Optimizations predicted that an intermediate ( $$\sim 30^\circ$$ ∼ 30 ∘ ) 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.Dillon WilliamsEric C. LeuthardtGuy M. GeninMohamed ZayedNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Dillon Williams Eric C. Leuthardt Guy M. Genin Mohamed Zayed Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
description	Abstract 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 ( $$<20^{\circ }$$ < 20 ∘ ) led to increased incidence of pathologically low shear rates, and that high graft-to-vein anastomosis angles ( $$>40^{\circ }$$ > 40 ∘ ) led to increased incidence of pathologically high shear rates. Optimizations predicted that an intermediate ( $$\sim 30^\circ$$ ∼ 30 ∘ ) 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.
format	article
author	Dillon Williams Eric C. Leuthardt Guy M. Genin Mohamed Zayed
author_facet	Dillon Williams Eric C. Leuthardt Guy M. Genin Mohamed Zayed
author_sort	Dillon Williams
title	Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
title_short	Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
title_full	Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
title_fullStr	Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
title_full_unstemmed	Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
title_sort	tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/7feefee451564b1985c4b81cfab48d92
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Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields

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