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Arteriovenous fistula (AVF) is the optimal form of vascular access for most haemodialysis dependant patients; however, it is prone to the formation of stenoses that compromise utility and longevity. Whilst there are many factors influencing the development of these stenoses, pathological flow-related phenomena may also incite the formation of intimal hyperplasia, and hence a stenosis. Repeated CFD-derived resistance was calculated for six patient who had a radiocephalic AVF, treated with an interwoven nitinol stent around the juxta-anastomotic region to address access dysfunction. A three-dimensional freehand ultrasound system was used to obtain patient-specific flow profiles and geometries, before performing CFD simulations to replicate the flow phenomena in the AVF, which enabled the calculation of CFD-derived resistance. We presented six patient cases who were examined before and after treatment and our results showed a 77% decrease in resistance, recorded after a surgical intervention to address access dysfunction. Problematic AVFs were found to have high resistance, particularly in the venous segment. AVFs with no reported clinical problems, and clinical patency, had low resistance in the venous segment. There did not appear to be any relationship with clinical problems/patency and resistance values in the arterial segment. Identifying changes in resistance along the circuit allowed stenoses to be identified, independent to that determined using standard sonographic criteria. Our exploratory study reveals thatCFD-derived resistance is a promising metric that allows for non-invasive identification of diseased AVFs. The pipeline analysis enabled regular surveillance of AVF to be studied to aid with surgical planning and outcome, further exhibiting its clinical utility. [ABSTRACT FROM AUTHOR]

• The impact of a stent on the AVF haemodynamics was numerically assessed. • The flow was funnelled within the stent in the malapposed regions of the vein. • Regions of low TAWSS and high OSI were smaller in the stented case. • Adverse haemodynamics were funnelled away from the vessel wall at the malapposition. An arteriovenous fistula (AVF), a vascular structure surgically created to enable haemodialysis, is commonly affected by stenosis in the juxta-anastomotic region. A new treatment involving the implantation of a flexible stent has shown good potential for retaining healthy AVFs. Since vascular disease in the AVF is known to be related to the haemodynamic environment within the vasculature, this study aims to understand the impact of the stent implantation on the flow dynamics within a single patient-specific AVF. A virtual stented geometry of the AVF was obtained with micro-CT images of a benchtop AVF model implanted with a Supera stent. Reynolds averaged Navier–Stokes simulations were conducted with physiological boundary conditions (Reynolds numbers varying from 345 to 730) applied on the AVF model with and without the presence of the stent. Velocity contour slices within the vein showed the concentration of high velocity in the stent encapsulated region. Moreover, the ratios of flow rate across the stent-lumen cross-sections over the flow rate across the vessel-lumen cross-sections suggested that the flow was being funnelled through the stent encapsulated regions of a malapposed section, despite the porous structure of the stent. A larger low velocity recirculation region translated to a larger vessel wall area of high Oscillatory Shear Index (OSI) and low Time-Averaged Wall Shear Stress (TAWSS) in the AVF model with the stent absent, compared to the stented model. This suggested that the adverse haemodynamic behaviour was being funnelled away from the vessel wall, possibly leading to a protective environment in the malapposed region of the vein. [ABSTRACT FROM AUTHOR]