Influence of Wall Compliance on the Flow Patterns in a Patient-Specific Brachio-Cephalic Arterio-Venous Fistula

Abstract

Patients with end stage renal disease require some form of vascular access for treatment, with Arterio-Venous Fistulas (avf) being the preferred form available due to better patency rates. However, they continue to present complications after creation, leading to early or late failure. While many studies are examining the flow in patient-specific fistulas, they often neglect the influence of vessel compliance on its hemodynamics. The objective of this study is to investigate the effect of wall compliance on the complex hemodynamics of a patient-specific brachio-cephalic avf and how it differs from a rigid fistula. Particle Image Velocimetry (piv) was used to capture the flow pattern within the fistula for both steady (Re = 1817) and pulsatile (Reav=1817, Remax=2232) flow conditions. The results were compared to rigid model measurements performed under the same Reynolds number. The streamline plots and coefficient of variation results did not differ significantly between the models; however, the non-dimensional velocity and directional variability results did vary between the two fistulas. A difference of approximately 8% was seen between the two models for both steady and pulsatile flow. The findings of this study suggest that to determine the bulk flow, a rigid model is adequate, but to capture the finer details of the flow, a compliant model is necessary.