The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography
The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations usi...
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Frontiers Media S.A.
2020-07-01
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| Online Access: | https://www.frontiersin.org/article/10.3389/fbioe.2020.00846/full |
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| author | Chih-Yu Yang Chih-Yu Yang Chih-Yu Yang Chih-Yu Yang Ming-Chia Li Ming-Chia Li Chien-Wen Lan Wang-Jiun Lee Chen-Ju Lee Cheng-Hsueh Wu Jing-Min Tang Yang-Yao Niu Yao-Ping Lin Yan-Ting Shiu Yan-Ting Shiu Alfred K. Cheung Alfred K. Cheung Yan-Hwa Wu Lee Yan-Hwa Wu Lee Oscar Kuang-Sheng Lee Oscar Kuang-Sheng Lee Oscar Kuang-Sheng Lee Shu Chien Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng |
| author_facet | Chih-Yu Yang Chih-Yu Yang Chih-Yu Yang Chih-Yu Yang Ming-Chia Li Ming-Chia Li Chien-Wen Lan Wang-Jiun Lee Chen-Ju Lee Cheng-Hsueh Wu Jing-Min Tang Yang-Yao Niu Yao-Ping Lin Yan-Ting Shiu Yan-Ting Shiu Alfred K. Cheung Alfred K. Cheung Yan-Hwa Wu Lee Yan-Hwa Wu Lee Oscar Kuang-Sheng Lee Oscar Kuang-Sheng Lee Oscar Kuang-Sheng Lee Shu Chien Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng |
| author_sort | Chih-Yu Yang |
| collection | DOAJ |
| description | The juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations using standardized AVF geometry, not the real-world patient images. The present study is the first CFD study to use angiographic images with patient-specific outcome information, i.e., the exact location of the AVF stenotic lesion. We conducted the CFD analysis utilizing patient-specific AVF geometric models to investigate hemodynamic parameters at different locations of an AVF, and the association between hemodynamic parameters and the anastomotic angle, particularly at the stenotic location. We analyzed 27 patients who used radio-cephalic AVF for hemodialysis and received an angiographic examination for juxta-anastomotic stenosis. The three-dimensional geometrical model of each patient’s AVF was built using the angiographic images, in which the shape and the anastomotic angle of the AVF were depicted. CFD simulations of AVF hemodynamics were conducted to obtain blood flow parameters at different locations of an AVF. We found that at the location of the stenotic lesion, the AV angle was significantly correlated with access flow disturbance (r = 0.739; p < 0.001) and flow velocity (r = 0.563; p = 0.002). Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that the AV angle determines the lesion’s flow disturbance with a high area under the curve value of 0.878. The ROC analysis also identified a cut-off value of the AV angle as 46.5°, above or below which the access flow disturbance was significantly different. By applying CFD analysis to real-world patient images, the present study provides evidence that an anastomotic angle wider than 46.5° might lead to disturbed flow generation, demonstrating a reference angle to adopt during the anastomosis surgery. |
| first_indexed | 2024-12-21T19:35:47Z |
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| spelling | doaj.art-b25274decaae40859526ad4df98deedd2022-12-21T18:52:36ZengFrontiers Media S.A.Frontiers in Bioengineering and Biotechnology2296-41852020-07-01810.3389/fbioe.2020.00846554455The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on AngiographyChih-Yu Yang0Chih-Yu Yang1Chih-Yu Yang2Chih-Yu Yang3Ming-Chia Li4Ming-Chia Li5Chien-Wen Lan6Wang-Jiun Lee7Chen-Ju Lee8Cheng-Hsueh Wu9Jing-Min Tang10Yang-Yao Niu11Yao-Ping Lin12Yan-Ting Shiu13Yan-Ting Shiu14Alfred K. Cheung15Alfred K. Cheung16Yan-Hwa Wu Lee17Yan-Hwa Wu Lee18Oscar Kuang-Sheng Lee19Oscar Kuang-Sheng Lee20Oscar Kuang-Sheng Lee21Shu Chien22Der-Cherng Tarng23Der-Cherng Tarng24Der-Cherng Tarng25Der-Cherng Tarng26Der-Cherng Tarng27Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanStem Cell Research Center, National Yang-Ming University, Taipei, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDepartment of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, TaiwanDepartment of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, TaiwanDepartment of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, TaiwanDepartment of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, TaiwanDivision of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Aerospace Engineering, Tamkang University, New Taipei City, TaiwanDepartment of Aerospace Engineering, Tamkang University, New Taipei City, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, United StatesVeterans Affairs Medical Center, Salt Lake City, UT, United StatesDivision of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT, United StatesVeterans Affairs Medical Center, Salt Lake City, UT, United StatesCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDepartment of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, TaiwanInstitute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, TaiwanStem Cell Research Center, National Yang-Ming University, Taipei, Taiwan0Institute of Engineering in Medicine, University of California, San Diego, San Diego, CA, United States0Institute of Engineering in Medicine, University of California, San Diego, San Diego, CA, United StatesInstitute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, TaiwanCenter for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, TaiwanDepartment of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan1Department and Institute of Physiology, School of Medicine, National Yang-Ming University, Taipei, TaiwanThe juxta-anastomotic stenosis of an arteriovenous fistula (AVF) is a significant clinical problem in hemodialysis patients with no effective treatment. Previous studies of AV anastomotic angles on hemodynamics and vascular wall injury were based on computational fluid dynamics (CFD) simulations using standardized AVF geometry, not the real-world patient images. The present study is the first CFD study to use angiographic images with patient-specific outcome information, i.e., the exact location of the AVF stenotic lesion. We conducted the CFD analysis utilizing patient-specific AVF geometric models to investigate hemodynamic parameters at different locations of an AVF, and the association between hemodynamic parameters and the anastomotic angle, particularly at the stenotic location. We analyzed 27 patients who used radio-cephalic AVF for hemodialysis and received an angiographic examination for juxta-anastomotic stenosis. The three-dimensional geometrical model of each patient’s AVF was built using the angiographic images, in which the shape and the anastomotic angle of the AVF were depicted. CFD simulations of AVF hemodynamics were conducted to obtain blood flow parameters at different locations of an AVF. We found that at the location of the stenotic lesion, the AV angle was significantly correlated with access flow disturbance (r = 0.739; p < 0.001) and flow velocity (r = 0.563; p = 0.002). Furthermore, the receiver operating characteristic (ROC) curve analysis revealed that the AV angle determines the lesion’s flow disturbance with a high area under the curve value of 0.878. The ROC analysis also identified a cut-off value of the AV angle as 46.5°, above or below which the access flow disturbance was significantly different. By applying CFD analysis to real-world patient images, the present study provides evidence that an anastomotic angle wider than 46.5° might lead to disturbed flow generation, demonstrating a reference angle to adopt during the anastomosis surgery.https://www.frontiersin.org/article/10.3389/fbioe.2020.00846/fullarteriovenous fistulaangiographyanastomotic anglestenosiscomputational fluid dynamicsdisturbed flow |
| spellingShingle | Chih-Yu Yang Chih-Yu Yang Chih-Yu Yang Chih-Yu Yang Ming-Chia Li Ming-Chia Li Chien-Wen Lan Wang-Jiun Lee Chen-Ju Lee Cheng-Hsueh Wu Jing-Min Tang Yang-Yao Niu Yao-Ping Lin Yan-Ting Shiu Yan-Ting Shiu Alfred K. Cheung Alfred K. Cheung Yan-Hwa Wu Lee Yan-Hwa Wu Lee Oscar Kuang-Sheng Lee Oscar Kuang-Sheng Lee Oscar Kuang-Sheng Lee Shu Chien Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng Der-Cherng Tarng The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography Frontiers in Bioengineering and Biotechnology arteriovenous fistula angiography anastomotic angle stenosis computational fluid dynamics disturbed flow |
| title | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
| title_full | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
| title_fullStr | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
| title_full_unstemmed | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
| title_short | The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography |
| title_sort | anastomotic angle of hemodialysis arteriovenous fistula is associated with flow disturbance at the venous stenosis location on angiography |
| topic | arteriovenous fistula angiography anastomotic angle stenosis computational fluid dynamics disturbed flow |
| url | https://www.frontiersin.org/article/10.3389/fbioe.2020.00846/full |
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