title: The effect of in-plane arterial curvature on blood flow and oxygen transport in arterio-venous fistulae.
abstract: Arterio-Venous Fistulae (AVF) are the preferred method of vascular access for patients with end stage renal disease who need hemodialysis. In this study, simulations of blood flow and oxygen transport were undertaken in various idealized AVF configurations. The objective of the study was to understand how arterial curvature affects blood flow and oxygen transport patterns within AVF, with a focus on how curvature alters metrics known to correlate with vascular pathology such as Intimal Hyperplasia (IH). If one subscribes to the hypothesis that unsteady flow causes IH within AVF, then the results suggest that in order to avoid IH, AVF should be formed via a vein graft onto the outer-curvature of a curved artery. However, if one subscribes to the hypothesis that low wall shear stress and/or low lumen-to-wall oxygen flux (leading to wall hypoxia) cause IH within AVF, then the results suggest that in order to avoid IH, AVF should be formed via a vein graft onto a straight artery, or the inner-curvature of a curved artery. We note that the recommendations are incompatible-highlighting the importance of ascertaining the exact mechanisms underlying development of IH in AVF. Nonetheless, the results clearly illustrate the important role played by arterial curvature in determining AVF hemodynamics, which to our knowledge has been overlooked in all previous studies.
authors.affiliation: Department of Aeronautics, Imperial College London , South Kensington, London SW7 2AZ, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Iori
authors.affiliation: Department of Aeronautics, Imperial College London , South Kensington, London SW7 2AZ, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Grechy
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital , London W12 0HS, United Kingdom.
authors.forename: R W
authors.identifier: 0000-0002-4607-8554
authors.initials: RW
authors.lastname: Corbett
authors.affiliation: St. Mary's Hospital , Praed Street, London W2 1NY, United Kingdom.
authors.forename: W
authors.initials: W
authors.lastname: Gedroyc
authors.affiliation: Imperial College Renal and Transplant Centre, Hammersmith Hospital , London W12 0HS, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Duncan
authors.affiliation: Department of Bioengineering, Imperial College London , South Kensington, London SW7 2AZ, United Kingdom.
authors.forename: C G
authors.initials: CG
authors.lastname: Caro
authors.affiliation: Department of Aeronautics, Imperial College London , South Kensington, London SW7 2AZ, United Kingdom.
authors.forename: P E
authors.initials: PE
authors.lastname: Vincent
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