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The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography
The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations usi...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390971/ https://www.ncbi.nlm.nih.gov/pubmed/32793578 http://dx.doi.org/10.3389/fbioe.2020.00846 |
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author | Yang, Chih-Yu Li, Ming-Chia Lan, Chien-Wen Lee, Wang-Jiun Lee, Chen-Ju Wu, Cheng-Hsueh Tang, Jing-Min Niu, Yang-Yao Lin, Yao-Ping Shiu, Yan-Ting Cheung, Alfred K. Lee, Yan-Hwa Wu Lee, Oscar Kuang-Sheng Chien, Shu Tarng, Der-Cherng |
author_facet | Yang, Chih-Yu Li, Ming-Chia Lan, Chien-Wen Lee, Wang-Jiun Lee, Chen-Ju Wu, Cheng-Hsueh Tang, Jing-Min Niu, Yang-Yao Lin, Yao-Ping Shiu, Yan-Ting Cheung, Alfred K. Lee, Yan-Hwa Wu Lee, Oscar Kuang-Sheng Chien, Shu Tarng, Der-Cherng |
author_sort | Yang, Chih-Yu |
collection | PubMed |
description | The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations using standardized AVF geometry, not the real-world patient images. The present study is the first CFD study to use angiographic images with patient-specific outcome information, i.e., the exact location of the AVF stenotic lesion. We conducted the CFD analysis utilizing patient-specific AVF geometric models to investigate hemodynamic parameters at different locations of an AVF, and the association between hemodynamic parameters and the anastomotic angle, particularly at the stenotic location. We analyzed 27 patients who used radio-cephalic AVF for hemodialysis and received an angiographic examination for juxta-anastomotic stenosis. The three-dimensional geometrical model of each patient’s AVF was built using the angiographic images, in which the shape and the anastomotic angle of the AVF were depicted. CFD simulations of AVF hemodynamics were conducted to obtain blood flow parameters at different locations of an AVF. We found that at the location of the stenotic lesion, the AV angle was significantly correlated with access flow disturbance (r = 0.739; p < 0.001) and flow velocity (r = 0.563; p = 0.002). Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that the AV angle determines the lesion’s flow disturbance with a high area under the curve value of 0.878. The ROC analysis also identified a cut-off value of the AV angle as 46.5°, above or below which the access flow disturbance was significantly different. By applying CFD analysis to real-world patient images, the present study provides evidence that an anastomotic angle wider than 46.5° might lead to disturbed flow generation, demonstrating a reference angle to adopt during the anastomosis surgery. |
format | Online Article Text |
id | pubmed-7390971 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-73909712020-08-12 The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography Yang, Chih-Yu Li, Ming-Chia Lan, Chien-Wen Lee, Wang-Jiun Lee, Chen-Ju Wu, Cheng-Hsueh Tang, Jing-Min Niu, Yang-Yao Lin, Yao-Ping Shiu, Yan-Ting Cheung, Alfred K. Lee, Yan-Hwa Wu Lee, Oscar Kuang-Sheng Chien, Shu Tarng, Der-Cherng Front Bioeng Biotechnol Bioengineering and Biotechnology The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations using standardized AVF geometry, not the real-world patient images. The present study is the first CFD study to use angiographic images with patient-specific outcome information, i.e., the exact location of the AVF stenotic lesion. We conducted the CFD analysis utilizing patient-specific AVF geometric models to investigate hemodynamic parameters at different locations of an AVF, and the association between hemodynamic parameters and the anastomotic angle, particularly at the stenotic location. We analyzed 27 patients who used radio-cephalic AVF for hemodialysis and received an angiographic examination for juxta-anastomotic stenosis. The three-dimensional geometrical model of each patient’s AVF was built using the angiographic images, in which the shape and the anastomotic angle of the AVF were depicted. CFD simulations of AVF hemodynamics were conducted to obtain blood flow parameters at different locations of an AVF. We found that at the location of the stenotic lesion, the AV angle was significantly correlated with access flow disturbance (r = 0.739; p < 0.001) and flow velocity (r = 0.563; p = 0.002). Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that the AV angle determines the lesion’s flow disturbance with a high area under the curve value of 0.878. The ROC analysis also identified a cut-off value of the AV angle as 46.5°, above or below which the access flow disturbance was significantly different. By applying CFD analysis to real-world patient images, the present study provides evidence that an anastomotic angle wider than 46.5° might lead to disturbed flow generation, demonstrating a reference angle to adopt during the anastomosis surgery. Frontiers Media S.A. 2020-07-23 /pmc/articles/PMC7390971/ /pubmed/32793578 http://dx.doi.org/10.3389/fbioe.2020.00846 Text en Copyright © 2020 Yang, Li, Lan, Lee, Lee, Wu, Tang, Niu, Lin, Shiu, Cheung, Lee, Lee, Chien and Tarng. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Bioengineering and Biotechnology Yang, Chih-Yu Li, Ming-Chia Lan, Chien-Wen Lee, Wang-Jiun Lee, Chen-Ju Wu, Cheng-Hsueh Tang, Jing-Min Niu, Yang-Yao Lin, Yao-Ping Shiu, Yan-Ting Cheung, Alfred K. Lee, Yan-Hwa Wu Lee, Oscar Kuang-Sheng Chien, Shu Tarng, Der-Cherng The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
title | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
title_full | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
title_fullStr | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
title_full_unstemmed | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
title_short | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
title_sort | anastomotic angle of hemodialysis arteriovenous fistula is associated with flow disturbance at the venous stenosis location on angiography |
topic | Bioengineering and Biotechnology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390971/ https://www.ncbi.nlm.nih.gov/pubmed/32793578 http://dx.doi.org/10.3389/fbioe.2020.00846 |
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