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Annals of Biomedical Engineering

, Volume 41, Issue 4, pp 657–668 | Cite as

Vascular Remodeling in Autogenous Arterio-Venous Fistulas by MRI and CFD

  • Monica SigovanEmail author
  • Vitaliy Rayz
  • Warren Gasper
  • Hugh F. Alley
  • Christopher D. Owens
  • David Saloner
Article

Abstract

Hemodynamic parameters play an important role in regulating vascular remodeling in arterio-venous fistula (AVF) maturation. Investigating the changes in hemodynamic parameters during AVF maturation is expected to improve our understanding of fistula failure, but very little data on actual temporal changes in human AVFs is available. The present study aimed to assess the feasibility of using a noncontrast-enhanced MRI protocol combined with CFD modeling to relate hemodynamic changes to vascular remodeling following native AVF placement. MR angiography (MRA) and MR velocimetry (MRV) data was acquired peri-operatively, 1 month, and 3 months later in three patients. Vascular geometries were obtained by segmentation of the MRA images. Pulsatile flow simulations were performed in the patient specific vascular geometries with time-dependent boundary conditions prescribed from MRV measurements. A principal result of the study is the description of WSS changes over time in the same patients. The disturbed flow observed in the venous segments resulted in a variability of the WSS distribution and could be responsible for the non-uniform remodeling of the vessel. The artery did not show regions of disturbed flow upstream from the anastomosis, which would be consistent with the uniform remodeling. MRI use demonstrated the ability to provide a comprehensive evaluation of clinically relevant information for the investigation of upper extremity AVFs. 3D geometry from MRA in combination with MRV provides the opportunity to perform detailed CFD analysis of local hemodynamics in order to determine flow descriptors affecting fistula maturation.

Keywords

Computational fluid dynamics Magnetic resonance imaging Vascular access Hemodialysis fistula Vascular remodeling WSS 

Notes

Acknowledgments

This work has been supported by a VA Merit award (DS), and a NIH grant NS059891 (VR).

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Copyright information

© Biomedical Engineering Society 2012

Authors and Affiliations

  • Monica Sigovan
    • 1
    Email author
  • Vitaliy Rayz
    • 1
  • Warren Gasper
    • 2
  • Hugh F. Alley
    • 2
  • Christopher D. Owens
    • 2
    • 3
  • David Saloner
    • 1
    • 4
  1. 1.Department of Radiology and Biomedical ImagingUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Department of Vascular SurgeryUniversity of CaliforniaSan FranciscoUSA
  3. 3.Vascular Surgery ServiceVA Medical CenterSan FranciscoUSA
  4. 4.Radiology ServiceVA Medical CenterSan FranciscoUSA

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