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Abstract: SA-PO016

Differential Hemodynamics Between Arteriovenous Fistulas With or Without Intervention Before Successful Use

Session Information

  • Bioengineering
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Bioengineering

  • 300 Bioengineering

Authors

  • Northrup, Hannah M., University of Utah, Salt Lake City, Utah, United States
  • He, Yong, University of Florida, Gainesville, Florida, United States
  • Le, Ha D.H., University of Utah, Salt Lake City, Utah, United States
  • Berceli, Scott A., University of Florida, Gainesville, Florida, United States
  • Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
  • Shiu, Yan-Ting Elizabeth, University of Utah, Salt Lake City, Utah, United States
Background

A significant number of arteriovenous fistulas (AVFs) fail to mature for dialysis. Although interventions promote maturation, functional primary patency loss is higher for AVFs with interventions (assisted maturation) than AVFs without interventions (unassisted maturation). Blood flow-associated hemodynamics are proposed to affect AVF remodeling. However, the optimal hemodynamic parameters for unassisted maturation are unclear.

Methods

Patients (n=6) underwent magnetic resonance imaging (MRI) at 1 day, 6 weeks, and 6 months after AVF creation surgery. Before successful use for hemodialysis, 3 AVFs required intervention and 3 did not. MRI of the AVFs were used to calculate lumen cross-sectional area (CSA) and perform computational fluid dynamics to analyze hemodynamics, i.e. velocity, wall shear stress (WSS), and vorticity.

Results

The no-intervention group and intervention group had similar pre-surgery vein diameter and 1-day post-surgery venous CSA. The no-intervention group had significantly larger 1-day venous velocity (0.97±0.67 m/s; mean±SD), WSS (333±336 dyne/cm2) and vorticity (1709±1290 1/s) than the intervention group (velocity=0.23±0.10 m/s; WSS=49±40 dyne/cm2; vorticity=493.1±227 1/s)(P<0.05). At 6 months, the no-intervention group had significantly larger venous CSA (43.5±27.4 mm2) than the intervention group (15.1±6.2 mm2)(P<0.05). No-intervention AVF arteries followed the same trend.

Conclusion

Lumen area and hemodynamic parameters differ between intervention and non-intervention AVF groups. Larger venous velocity, WSS, and vorticity immediately after AVF creation surgery may be important for later lumen enlargement and AVF maturation.

Funding

  • NIDDK Support