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Increased Inlet Blood Flow Velocity Predicts Low Wall Shear Stress in the Cephalic Arch of Patients with Brachiocephalic Fistula Access.
- Source :
-
PloS one [PLoS One] 2016 Apr 13; Vol. 11 (4), pp. e0152873. Date of Electronic Publication: 2016 Apr 13 (Print Publication: 2016). - Publication Year :
- 2016
-
Abstract
- Background: An autogenous arteriovenous fistula is the optimal vascular access for hemodialysis. In the case of brachiocephalic fistula, cephalic arch stenosis commonly develops leading to access failure. We have hypothesized that a contribution to fistula failure is low wall shear stress resulting from post-fistula creation hemodynamic changes that occur in the cephalic arch.<br />Methods: Twenty-two subjects with advanced renal failure had brachiocephalic fistulae placed. The following procedures were performed at mapping (pre-operative) and at fistula maturation (8-32 weeks post-operative): venogram, Doppler to measure venous blood flow velocity, and whole blood viscosity. Geometric and computational modeling was performed to determine wall shear stress and other geometric parameters. The relationship between hemodynamic parameters and clinical findings was examined using univariate analysis and linear regression.<br />Results: The percent low wall shear stress was linearly related to the increase in blood flow velocity (p < 0.01). This relationship was more significant in non-diabetic patients (p < 0.01) than diabetic patients. The change in global measures of arch curvature and asymmetry also evolve with time to maturation (p < 0.05).<br />Conclusions: The curvature and hemodynamic changes during fistula maturation increase the percentage of low wall shear stress regions within the cephalic arch. Low wall shear stress may contribute to subsequent neointimal hyperplasia and resultant cephalic arch stenosis. If this hypothesis remains tenable with further studies, ways of protecting the arch through control of blood flow velocity may need to be developed.
- Subjects :
- Adult
Aged
Aged, 80 and over
Brachiocephalic Trunk surgery
Female
Humans
Kidney Failure, Chronic physiopathology
Male
Middle Aged
Prospective Studies
Stress, Mechanical
Young Adult
Arteriovenous Shunt, Surgical
Blood Flow Velocity physiology
Brachiocephalic Trunk physiopathology
Kidney Failure, Chronic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1932-6203
- Volume :
- 11
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- PloS one
- Publication Type :
- Academic Journal
- Accession number :
- 27074019
- Full Text :
- https://doi.org/10.1371/journal.pone.0152873