Bartlett Matthew, Bonfanti Mirko, Diaz-Zuccarini Vanessa, Tsui Janice
Division of Surgery & Interventional Science, University College London, Royal Free Campus, NW3 2QG London, UK.
Department of Vascular Surgery, Royal Free London NHS Foundation Trust, NW3 2QG London, UK.
Rev Cardiovasc Med. 2024 Jan 22;25(1):35. doi: 10.31083/j.rcm2501035. eCollection 2024 Jan.
Oscillatory wall shear stress and related metrics have been identified as potential predictors of dialysis access outcomes; however, the absence of a simple non-invasive method for measuring these haemodynamic forces has been prohibitive to their adoption into routine clinical practice. We present a computationally enhanced, single patient case study, offering a unique insight into the haemodynamic environment surrounding the development of flow limiting neointimal hyperplasia within the efferent vein of a previously functional arteriovenous fistula (AVF).
Computational fluid dynamics (CFD) simulations were used to create a quantitative map of oscillatory shear stress as well as enabling visualisation of streamline patterns within the AVF. CFD data was compared to ultrasound-based turbulence quantification and examined alongside structural and functional changes in the access site over time.
This work further supports the notion that flow limiting neointimal hyperplasia development in vascular access fistulae, occurs in response to oscillatory wall shear stress, and provides proof of concept for the idea that non-invasive ultrasound turbulence quantification tools could play a role in predicting vascular access outcomes.
In addition to providing insight into the haemodynamic environment surrounding the development of flow limiting neointimal hyperplasia, we hope that this paper will promote discussion and further thinking about how our learnings from studies can be incorporated into clinical practice through novel uses of existing diagnostic tools.
振荡壁面剪应力及相关指标已被确定为透析通路预后的潜在预测指标；然而，缺乏一种简单的非侵入性方法来测量这些血流动力学力，这阻碍了它们在常规临床实践中的应用。我们展示了一个经过计算增强的单病例研究，为深入了解先前功能正常的动静脉内瘘（AVF）传出静脉中导致血流受限的新生内膜增生发展的血流动力学环境提供了独特视角。
采用计算流体动力学（CFD）模拟来创建振荡剪应力的定量图谱，并实现对AVF内流线模式的可视化。将CFD数据与基于超声的湍流定量进行比较，并随时间观察通路部位的结构和功能变化。
这项工作进一步支持了以下观点，即血管通路瘘管中导致血流受限的新生内膜增生是对振荡壁面剪应力的反应，并为无创超声湍流定量工具可在预测血管通路预后中发挥作用这一观点提供了概念验证。
除了深入了解导致血流受限的新生内膜增生发展的血流动力学环境外，我们希望本文将促进关于如何通过现有诊断工具的新用途将我们从研究中获得的知识纳入临床实践的讨论和进一步思考。
