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The surgical creation of an artery-vein connection via a Brachicephalic fistula (BCF) in patients with end stage renal disease (ESRD) provides a unique opportunity to study blood vessel response mechanisms to extreme hemodynamic conditions in relatively short timeframes. After BCF creation, the flow rate in the vein increases by an order of magnitude leading to separated flows and corresponding abnormally low, or negative, wall shear stress (WSS) in the curved arch segment of the cephalic vein. Locations of abnormally low WSS are shown to correlate with development of neointimal hyperplasia (NH) and subsequent stenosis. It is found that the stenosis, prior to a surgical intervention, restores the normal physiological WSS in the vein. As a result, this investigation provides evidence that the adaptation principle, known to apply in the arterial system, is also valid in the venous system. A novel graphical method is developed that combines clinical and computational data to assist in interpreting these physiological mechanisms including adaptation that lead to changes in vein geometry over time.

An exegesis of a novel mechanism leading to vortex splitting and subsequent shedding that is valid for two-dimensional incompressible, inviscid or viscous, and external or internal or wall-bounded flows, is detailed in this research. The mechanism, termed the Vortex-Shedding Mechanism (VSM), is simple and intuitive, requiring only two coincident conditions in the flow: (1) the existence of a location with zero momentum and (2) the presence of a net force having a positive divergence. Numerical solutions of several model problems illustrate causality of the VSM. Moreover, the VSM criteria is proved to be a necessary and sufficient condition for a vortex splitting event in any two-dimensional, incompressible flow. The VSM is shown to exist in several canonical problems including the external flow past a circular cylinder. Suppression of the von Kármán vortex street is demonstrated for Reynolds numbers of 100 and 400 by mitigating the VSM.

This paper provides a brief review of the analytical and numerical developments related to unsteady boundary-layer separation, in particular as it relates to vortex-induced flows, leading up to our present understanding of this important feature in high-Reynolds-number, surface-bounded flows in the presence of an adverse pressure gradient. In large part, vortex-induced separation has been the catalyst for pulling together the theory, numerics and applications of unsteady separation. Particular attention is given to the role that Prof. Frank T. Smith, FRS, has played in these developments over the course of the past 35 years. The following points will be emphasized: (i) unsteady separation plays a pivotal role in a wide variety of high-Reynolds-number flows, (ii) asymptotic methods have been instrumental in elucidating the physics of both steady and unsteady separation, (iii) Frank T. Smith has served as a catalyst in the application of asymptotic methods to high-Reynolds-number flows, and (iv) there is still much work to do in articulating a complete theoretical understanding of unsteady boundary-layer separation., (© 2014 The Author(s) Published by the Royal Society. All rights reserved.)

Numerical simulations of the unsteady, two-dimensional, incompressible Navier-Stokes equations are performed for a Newtonian fluid in a channel having a symmetric constriction modeled by a two-parameter Gaussian distribution on both channel walls. The Reynolds number based on inlet half-channel height and mean inlet velocity ranges from 1 to 3000. Constriction ratios based on the half-channel height of 0.25, 0.5, and 0.75 are considered. The results show that both the Reynolds number and constriction geometry have a significant effect on the behavior of the post-constriction flow field. The Navier-Stokes solutions are observed to experience a number of bifurcations: steady attached flow, steady separated flow (symmetric and asymmetric), and unsteady vortex shedding downstream of the constriction depending on the Reynolds number and constriction ratio. A sequence of events is described showing how a sustained spatially growing flow instability, reminiscent of a convective instability, leads to the vortex shedding phenomenon via a proposed streamwise pressure-gradient mechanism.

Background: Fistula access in chronic haemodialysis patients is recommended. The first and second choice for location of fistula placement is radial-cephalic followed by the brachiocephalic fistula. Fistula access using the cephalic vein often results in cephalic arch stenosis that is less common in diabetics for unclear reasons. The objective of the current study is to determine if geometry of the cephalic arch differs between diabetics and non-diabetics., Methods: In a retrospective design, 57 patients with brachiocephalic fistula access had radiology films of the cephalic arch reviewed for geometric analysis. Twelve patients were excluded from final analysis because of stent placement in the cephalic arch. Measurements made included diameter of the cephalic vein, minimum radius of curvature and angle of the arch. Demographics were statistically analysed to determine the association with the geometric measurements., Results: Global and local measurements showed evidence of two arch types. Wider arch angles and larger R/d were associated with diabetes by univariate (P < 0.05) and multivariate analyses (P < 0.05). A wider arch angle was also associated with a history of right permcath access by multivariable analysis (P = 0.042)., Conclusions: Based on this study, it was found that there are two distinct types of cephalic arch geometries. Patients having diabetes mellitus show a significant probability of having a larger R/d ratio and wider arch angle. This study has given insight into structural alterations in geometry of the cephalic arch of diabetics with brachiocephalic fistula access.

Numerical solutions of the flow induced by a thick-core vortex have been obtained using the unsteady, two-dimensional Navier-Stokes equations. The presence of the vortex causes an adverse pressure gradient along the surface, which leads to unsteady separation. The calculations by Brinckman and Walker for a similar flow identify a possible instability, purported to be an inviscid Rayleigh instability, in the region where ejection of near-wall vorticity occurs during the unsteady separation process. In results for a range of Reynolds numbers in the present investigation, the oscillations are also found to occur. However, they can be eliminated with increased grid resolution. Despite this behaviour, the instability may be physical but requires a sufficient amplitude of disturbances to be realized.