Bartlett, Matthew;
Bonfanti, Mirko;
Diaz-Zuccarini, Vanessa;
Tsui, Janice;
(2024)
Computationally Enhanced, Haemodynamic Case Study of Neointimal Hyperplasia Development in a Dialysis Access Fistula.
Reviews in Cardiovascular Medicine
, 25
(1)
, Article 35. 10.31083/j.rcm2501035.
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Abstract
Background: 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). Methods: 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. Results: 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. Conclusions: 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 in-silico studies can be incorporated into clinical practice through novel uses of existing diagnostic tools.
| Type: | Article |
|---|---|
| Title: | Computationally Enhanced, Haemodynamic Case Study of Neointimal Hyperplasia Development in a Dialysis Access Fistula |
| Location: | Singapore |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.31083/j.rcm2501035 |
| Publisher version: | http://dx.doi.org/10.31083/j.rcm2501035 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, ultrasound, dialysis access, haemodynamics, turbulence intensity, ARTERIOVENOUS-FISTULA, DISTURBED FLOW, INTIMAL HYPERPLASIA, CAROTID BIFURCATION, HEMODIALYSIS, STENOSIS, BLOOD |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10197504 |
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