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Optimizing venous anastomosis angle for arteriovenous graft with intimal hyperplasia using computational fluid dynamics

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Abstract

Vascular access (VA), a renal failure therapy, is often performed using an arteriovenous (AV) graft for patients with veins and arteries that cannot be connected with autologous blood vessels. However, VA using AV grafts can change the blood flow and lead to intimal hyperplasia (IH), causing the damage on blood vessel and failure of VA. In our study, we investigated the effect of the anastomosis angle on blood vessel damage under various IH formation conditions. We simulated the blood flow near the anastomosis between vein and AV graft and quantitatively evaluated the blood vessel damage using hemodynamic factors, such as wall shear stress (WSS). Our results show that smaller anastomosis angle reduces damage to blood vessels and prevents IH formation and growth regardless of IH progression, shape, and position. These results can contribute to optimization of the anastomosis angle during VA surgery to improve a patient’s prognosis.

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Abbreviations

d vein :

Diameter of vein

d graft :

Diameter of AV graft

d p :

Distance between peak of the IH and the anastomosis

p graft :

Pressure on inlet of AV graft

\(\dot Y\) :

Shear rate

h c :

Height of IH for concentric shape

h e :

Height of IH for eccentric shape

I :

Unit tensor

μ 0 :

Viscosity at a shear rate of zero

μ inf :

Viscosity at an infinite shear rate

n :

Power index

p :

Pressure

λ :

Relaxation time

ρ :

Density of working fluid

t :

Time

ϸ :

Venous anastomosis angle

u :

Blood flow velocity vector

w :

Width of IH

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Acknowledgments

This work was supported by the Basic Science Research Program through a National Research Foundation of Korea (NRF) grant funded by the Ministry of Science, ICT & Future Planning (NRF2020R1A2C3010568), the Basic Science Research Program through the NRF funded by the Ministry of Education (NRF2021R1A6A1A03039696), and SKKU-SMC Future Convergence Research Program grant.

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Author notes

  1. These authors equally contributed to this work as first author.

Authors and Affiliations

  1. Department of Surgery, Uijeongbu St’ Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, 11765, Korea

    Sangkyun Mok

  2. School of Mechanical Engineering, Sungkyunkwan University, Suwon, 16419, Korea

    Seongsu Cho, Jihyeong Lee & Jinkee Lee

  3. Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St’ Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Korea

    Jang Yong Kim, Sang Seob Yun & Sun Cheol Park

  4. Department of Surgery, Yeouido St’ Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, Korea

    Young Jun Park

  5. Institute of Quantum Biophysics, Sungkyunkwan University, Suwon, 16419, Korea

    Jinkee Lee

Authors
  1. Sangkyun Mok
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  2. Seongsu Cho
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  3. Jihyeong Lee
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  5. Sang Seob Yun
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  6. Young Jun Park
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  7. Sun Cheol Park
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  8. Jinkee Lee
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Corresponding authors

Correspondence to Sun Cheol Park or Jinkee Lee.

Additional information

Sun Cheol Park, M.D., Ph.D., RVT, RPVI, received his M.D., M.S. and Ph.D. from The Catholic University of Korea, Korea. Since 2004, he has been a Professor at Department of Surgery of The Catholic University of Korea, Korea. His surgical and research interests include transplant and vascular surgery, vascular access and hemodynamic simulations.

Jinkee Lee, Ph.D., received his B.S. and M.S. degrees from Korea Advanced Institute of Science and Technology, and his Ph.D. from Brown University, USA. Since 2012, he has been a Professor at the School of Mechanical Engineering and Institute of Quantum Biophysics of Sungkyunkwan University, Korea. His research interests include interfacial flow, microfluidics, biomimetics and biofluidics.

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Mok, S., Cho, S., Lee, J. et al. Optimizing venous anastomosis angle for arteriovenous graft with intimal hyperplasia using computational fluid dynamics. J Mech Sci Technol 37, 5231–5238 (2023). https://doi.org/10.1007/s12206-023-0925-4

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  • DOI: https://doi.org/10.1007/s12206-023-0925-4

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