Computational fluid dynamic evaluation of the side-to-side anastomosis for arteriovenous fistula

被引:37
|
作者
Hull, Jeffrey E. [1 ]
Balakin, Boris V. [2 ]
Kellerman, Brad M. [3 ]
Wrolstad, David K. [3 ]
机构
[1] Richmond Vasc Ctr, North Chesterfield, VA 23236 USA
[2] Univ Bergen, Bergen, Norway
[3] Caymus Med, San Juan Capistrano, CA USA
关键词
HEMODYNAMICS; STENOSIS; SIZE;
D O I
10.1016/j.jvs.2012.10.070
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: The goal of this research was to compare side-to-side (STS) and end-to-side (ETS) anastomoses in a computer model of the arteriovenous fistula with computational fluid dynamic analysis. Methods: A matrix of 17 computer arteriovenous fistula models (SolidWorks, Dassault Systemes, France) of artery-vein pairs (3-mm-diameter artery + 3-mm-diameter vein and 4-mm-diameter artery +6-mm-diameter vein elliptical anastomoses) in STS, 45 degrees ETS, and 90 degrees ETS configurations with cross-sectional areas (CSAs) of 3.5 to 18.8 mm(2) were evaluated with computational fluid dynamic software (STAR-CCM+; CD-adapco, Melville, NY) in simulations at defined flow rates from 600 to 1200 mL/min and mean arterial pressures of 50 to 140 mm Hg. Models and configurations were evaluated for pressure drop across the anastomosis, arterial inflow, venous outflow, arterial outflow, velocity vector, and wall shear stress (WSS) profile. Results: Pressure drop across the anastomosis was inversely proportional to anastomotic CSA and to venous outflow and was proportional to arterial inflow. Pressure drop was greater in 3 + 3 models than in 4 + 6 STS models; 90 degrees ETS configurations had the lowest pressure drops and were nearly identical, whereas 45 degrees ETS configurations had the highest pressure drops. Venous outflow in the 4 + 6 model in STS configurations, evaluated at 100 mm Hg arterial inflow pressure, was 390, 592, 610, and 886 mL/min in anastomotic CSAs of 3.5, 5.3, 7.1, and 18.8 mm(2), respectively, and was similar in 90 degrees ETS (609 and 908 mL/min) and lower in 45 degrees ETS (534 and 562 mL/min) configurations at CSAs of 5.3 and 18.8 mm(2). The mean increase in venous outflow was 69 mL/min (range, -59 to 134) between 3 D 3 and 4 D 6 models at 100 mm Hg arterial inflow. The most uniform WSS profile occurs in STS anastomoses followed by 45 degrees ETS and then 90 degrees ETS anastomoses. Conclusions: The STS and 90 degrees ETS anastomoses have high venous outflow and a tendency toward reversed arterial outflow. The 45 degrees ETS anastomosis has reduced venous outflow but resists reversed arterial outflow. The STS anastomosis has more uniform WSS characteristics compared with the 45 degrees and 90 degrees ETS anastomoses.
引用
收藏
页码:187 / +
页数:8
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