Longitudinal Assessment of Hemodynamic Endpoints in Predicting Arteriovenous Fistula Maturation

作者：Ehsan Rajabi‐Jagahrgh, Mahesh Krishnamoorthy, Prabir Roy‐Chaudhury, Paul Succop, Yang Wang, Ann Choe, Rupak K. Banerjee · 发表于：Seminars in Dialysis · 年份：2012 · DOI：10.1111/j.1525-139x.2012.01112.x · 被引用次数：22 · 研究领域：Central Venous Catheters and Hemodialysis、Vascular Procedures and Complications、Vascular Malformations Diagnosis and Treatment

Arteriovenous fistula (AVF) nonmaturation is currently a significant clinical problem; however, the mechanisms responsible for this have remained unanswered. Previous work by our group and others has suggested that anatomical configuration and the corresponding hemodynamic endpoints could have an important role in AVF remodeling. Thus, our goal was to assess the longitudinal (temporal) effect of wall shear stress (WSS) on remodeling process of AVFs with two different configurations. The hypothesis is that early assessment of hemodynamic endpoints such as temporal gradient of WSS will predict the maturation status of AVF at later time points. Two AVFs with curved (C-AVF) and straight (S-AVF) configurations were created between the femoral artery and vein of each pig. Three pigs were considered in this study and in total six AVFs (three C-AVF and three S-AVF) were created. The CT scan and ultrasound were utilized to numerically evaluate local WSS at 20 cross-sections along the venous segment of AVFs at 2D (D: days), 7D, and 28D postsurgery. These cross-sections were located at 1.5 mm increments from the anastomosis junction. Local WSS values at these cross-sections were correlated with their corresponding luminal area over time. The WSS in C-AVF decreased from 22.3 ± 4.8 dyn/cm(2) at 2D to 4.1 ± 5.1 dyn/cm(2) at 28D, while WSS increased in S-AVF from 13.0 ± 5.0 dyn/cm(2) at 2D to 36.7 ± 5.3 dyn/cm(2) at 28D. Corresponding to these changes in WSS levels, luminal area of C-AVF di...