Li Yong-Jiang, Hou Hui-Min, Liu Zheng, Xue Chun-Dong, Na Jing-Tong, Meng Qing-Mei, Li Zhe-Yuan, Sun Hai-Yang, Wu Yu-Lin, Liu Shu-Xin, Qin Kai-Rong
Institute of Cardio-Cerebrovascular Medicine, Central Hospital of Dalian University of Technology, Dalian, Liaoning, China.
School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, Liaoning, China.
Front Bioeng Biotechnol. 2025 Mar 20;13:1551993. doi: 10.3389/fbioe.2025.1551993. eCollection 2025.
The dramatic hemodynamic disturbances induced by arteriovenous fistula (AVF) creation are universally acknowledged as the triggering factors for AVF dysfunction. The postoperative blood redistribution is greatly relevant with the flow disturbances of the AVF, such as disturbed flow, low wall shear stress (WSS), and oscillating WSS. However, the relationship between blood redistribution and hemodynamic disturbances of AVF remains unexamined. The role of clinically observed retrograde blood flow at the distal radial artery is rarely understood.
In this study, an idealized AVF model was developed with clinical data collected from end-stage renal disease patients. By considering the postoperative blood redistribution, the influence of the blood flow rate ratio on hemodynamic disturbances is numerically studied.
The results demonstrate that the creation of the AVF can result in flow disturbances such as vortex, reciprocating flow, and low and reciprocating WSS, whose occurrence regions are consistent with clinical observations. The flow rate ratio and flow direction of the distal radial artery play important roles in regulating the low-WSS area within the AVF anastomosis, especially for the flow rate of the proximal radial artery (PRA). Moreover, the clinically observed retrograde blood flow in the distal radial artery contributes to the reduction in the low-WSS area, revealing a compensatory mechanism. This study can provide valuable insights for understanding the effect of blood redistribution on flow disturbances in the AVF, as well as the compensatory role of the retrograde distal radial artery flow, which helps optimize blood redistribution for a well-functioning AVF.
动静脉内瘘（AVF）建立所引发的剧烈血流动力学紊乱被公认为是AVF功能障碍的触发因素。术后血液再分布与AVF的血流紊乱密切相关，如血流紊乱、低壁面切应力（WSS）和振荡WSS。然而，血液再分布与AVF血流动力学紊乱之间的关系仍未得到研究。临床上观察到的桡动脉远端逆行血流的作用鲜为人知。
在本研究中，利用从终末期肾病患者收集的临床数据建立了一个理想化的AVF模型。通过考虑术后血液再分布，数值研究了血流率比对血流动力学紊乱的影响。
结果表明，AVF的建立可导致血流紊乱，如涡流、往复流以及低和往复WSS，其发生区域与临床观察结果一致。桡动脉远端的血流率比和血流方向在调节AVF吻合口内的低WSS区域方面起着重要作用，尤其是对于桡动脉近端（PRA）的血流率。此外，临床上观察到的桡动脉远端逆行血流有助于减少低WSS区域，揭示了一种代偿机制。本研究可为理解血液再分布对AVF血流紊乱的影响以及桡动脉远端逆行血流的代偿作用提供有价值的见解，这有助于优化血液再分布以实现功能良好的AVF。
