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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
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.
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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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