Hemodynamics in the cephalic arch of a brachiocephalic fistula.
The care and outcome of patients with end stage renal disease (ESRD) on chronic hemodialysis is directly dependent on their hemodialysis access. A brachiocephalic fistula (BCF) is commonly placed in the elderly and in patients with a failed lower-arm, or radiocephalic, fistula. However, there are numerous complications such that the BCF has an average patency of only 3.6 years. A leading cause of BCF dysfunction and failure is stenosis in the arch of the cephalic vein near its junction with the axillary vein, which is called cephalic arch stenosis (CAS). Using a combined clinical and computational investigation, we seek to improve our understanding of the cause of CAS, and to develop a means of predicting CAS risk in patients with a planned BCF access. This paper details the methodology used to determine the hemodynamic consequences of the post-fistula environment and illustrates detailed results for a representative sample of patient-specific anatomies, including a single, bifurcated, and trifurcated arch. It is found that the high flows present due to fistula creation lead to secondary flows in the arch owing to its curvature with corresponding low wall shear stresses. The abnormally low wall shear stress locations correlate with the development of stenosis in the singular case that is tracked in time for a period of one year.
Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States. Electronic address: boghmic@iit.edu.
M
M
Boghosian
Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States.
K
K
Cassel
Nephrology, Department of Medicine, University of Chicago, Chicago, IL, United States.
M
M
Hammes
Vascular and Interventional Radiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States.
B
B
Funaki
Vascular and Interventional Radiology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, United States.
S
S
Kim
Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States.
X
X
Qian
Mechanical, Materials, and Aerospace Engineering Department, Illinois Institute of Technology, Chicago, IL, United States.
X
X
Wang
Biomedical Engineering Department, Illinois Institute of Technology, Chicago, IL, United States.
P
P
Dhar
Nephrology, Department of Medicine, University of Chicago, Chicago, IL, United States.
J
J
Hines
D001163:Arteriovenous Anastomosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D001794:Blood Pressure; D001809:Blood Viscosity; D001916:Brachial Artery / Q000503:physiopathology* / Q000601:surgery; D016121:Brachiocephalic Veins / Q000503:physiopathology* / Q000601:surgery; D003198:Computer Simulation; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D006435:Renal Dialysis / Q000009:adverse effects; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography
Brachiocephalic; Cephalic arch; Fistula; Intimal hyperplasia; Stenosis