Reduction in anastomotic flow disturbance within a modified end-to-side arteriovenous fistula configuration: Results of a computational flow dynamic model.

AIM

We sought to determine if a modification to the peri-anastomotic vein configuration during end-to-side arteriovenous fistula (AVF) creation would achieve a favourable haemodynamic environment compared with the standard acute-angle AVF.

METHODS

Computational fluid dynamics (CFD) modelling of two end-to-side AVF geometries (smooth-vein-loop vs. acute-angle) allowed for haemodynamic modelling. Haemodynamic fields at various stages of the pulse cycle were observed and compared across both models.

RESULTS

We found a significant reduction in flow disturbance in the modified shape at the peri-anastomotic vein region, a common site for stenosis. The acute anastomotic angle characteristic of a standard-end-to-side AVF was found to cause significant flow disturbance throughout the pulse cycle.

CONCLUSION

Computational modelling indicates that improvements in the haemodynamic environment of an AVF are achievable when a gentle change in direction is present in the vein segment. This may lead to improved maturation and AVF patency through reduction in disturbed flow patterns.