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Influence of an Arterial Stenosis on the Hemodynamics Within an Arteriovenous Fistula (AVF): Comparison Before and After Balloon-Angioplasty

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Abstract

The study focuses on arterial stenoses in arteriovenous fistulae (AVF), the occurrence of which was long underestimated. The objective is to investigate their influence on the hemodynamic conditions within the AVF. A numerical simulation of the blood flow is conducted within a patient-specific arteriovenous fistula that presents an 60% stenosis on the inflow artery. In order to find the vessel shape without stenosis and compare the flow conditions with and without stenosis, the endovascular treatment of balloon-angioplasty is simulated by modeling the vessel deformation during balloon inflation implicitly. Clinically, balloon-angioplasty is considered successful if the post-treatment residual degree of stenosis is below 30%. Different balloon inflation pressures have been imposed numerically to obtain residual degrees of stenosis between 30 and 0%. The comparison of the computational fluid dynamic simulations carried out in the patient-specific native geometry and in the treated ones shows that the arterial stenosis has little impact on the blood flow distribution. The venous flow rate remains unchanged as long as thrombosis does not occur: the nominal flow rate needed for hemodialysis is maintained, which is not the case for a venous stenosis. An arterial stenosis, however, causes an increase in the pressure difference across the stenosed region. A residual degree of stenosis below 20% is needed to guarantee a pressure difference lower than 5 mmHg, which is considered to be the threshold stenosis pressure difference.

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Acknowledgments

This research is funded by the European Commission, through the MeDDiCA ITN (www.meddica.eu, Marie Curie Actions, grant agreement PITN-GA-2009-238113) and by the French Ministère de la Recherche (Pilcam2 grant). The authors gratefully acknowledge Polyclinique St Côme (Compiègne, FRANCE) for the medical images.

Conflict of Interest

None.

Statement of Human Studies

The clinical images were acquired in 2004 in conformity to the standards of use of medical images (patient consent, secured transfer of anonymized data).

Statement of Animal Studies

N/A.

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Authors and Affiliations

  1. Biomechanics and Bioengineering Laboratory (UMR CNRS 7338), Université de Technologie de Compiègne, CS 60319, 60203, Compiègne Cedex, France

    Iolanda Decorato, Anne-Virginie Salsac, Cecile Legallais & Zaher Kharboutly

  2. Mechanical Engineering Dept, University College London, Torrington Place, London, WC1E 7JE, UK

    Mona Alimohammadi & Vanessa Diaz-Zuccarini

Authors
  1. Iolanda Decorato
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  2. Anne-Virginie Salsac
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  3. Cecile Legallais
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  6. Zaher Kharboutly
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Correspondence to Anne-Virginie Salsac.

Additional information

Associate Editor Ajit P. Yoganathan oversaw the review of this article.

MeDDiCA ITN (Marie Curie Actions, grant agreement PITN-GA-2009-238113).

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Decorato, I., Salsac, AV., Legallais, C. et al. Influence of an Arterial Stenosis on the Hemodynamics Within an Arteriovenous Fistula (AVF): Comparison Before and After Balloon-Angioplasty. Cardiovasc Eng Tech 5, 233–243 (2014). https://doi.org/10.1007/s13239-014-0185-7

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  • DOI: https://doi.org/10.1007/s13239-014-0185-7

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