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Blood Flow in Idealized Vascular Access for Hemodialysis: A Review of Computational Studies

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Abstract

Although our understanding of the failure mechanism of vascular access for hemodialysis has increased substantially, this knowledge has not translated into successful therapies. Despite advances in technology, it is recognized that vascular access is difficult to maintain, due to complications such as intimal hyperplasia. Computational studies have been used to estimate hemodynamic changes induced by vascular access creation. Due to the heterogeneity of patient-specific geometries, and difficulties with obtaining reliable models of access vessels, idealized models were often employed. In this review we analyze the knowledge gained with the use of computational such simplified models. A review of the literature was conducted, considering studies employing a computational fluid dynamics approach to gain insights into the flow field phenotype that develops in idealized models of vascular access. Several important discoveries have originated from idealized model studies, including the detrimental role of disturbed flow and turbulent flow, and the beneficial role of spiral flow in intimal hyperplasia. The general flow phenotype was consistent among studies, but findings were not treated homogeneously since they paralleled achievements in cardiovascular biomechanics which spanned over the last two decades. Computational studies in idealized models are important for studying local blood flow features and evaluating new concepts that may improve the patency of vascular access for hemodialysis. For future studies we strongly recommend numerical modelling targeted at accurately characterizing turbulent flows and multidirectional wall shear disturbances.

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Acknowledgments

The authors would like to thank Kerstin Mierke for editorial assistance during preparation of the manuscript.

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BE-I and AR declare that they have no conflict of interest.

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  1. Laboratory of Biomedical Technologies, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, IRCCS – Istituto di Ricerche Farmacologiche “Mario Negri”, Via G.B. Camozzi 3, 24020, Ranica, BG, Italy

    Bogdan Ene-Iordache & Andrea Remuzzi

  2. Department of Management, Information and Production and Engineering, University of Bergamo, Dalmine, BG, Italy

    Andrea Remuzzi

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  1. Bogdan Ene-Iordache
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Correspondence to Bogdan Ene-Iordache.

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Associate Editors James E. Moore, Jr., Michael Walsh, and Ajit P. Yoganathan oversaw the review of this article.

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Ene-Iordache, B., Remuzzi, A. Blood Flow in Idealized Vascular Access for Hemodialysis: A Review of Computational Studies. Cardiovasc Eng Tech 8, 295–312 (2017). https://doi.org/10.1007/s13239-017-0318-x

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