Toward longitudinal studies of hemodynamically induced vessel wall remodeling

Autor: Sandro Sironi, Michela Bozzetto, Paolo Brambilla, Giuseppe Remuzzi, Andrea Remuzzi, Bogdan Ene-Iordache, Stefano Rota
Přispěvatelé: Bozzetto, M, Brambilla, P, Rota, S, Ene-Iordache, B, Sironi, S, Remuzzi, G, Remuzzi, A
Rok vydání: 2018
Předmět:
Male
medicine.medical_specialty
Time Factors
Arteriovenous fistula
Computational fluid dynamics
Hemodialysis
Magnetic resonance imaging
Vascular access

medicine.medical_treatment
Arteriovenous fistula
computational fluid dynamics
hemodialysis
magnetic resonance imaging
vascular access
0206 medical engineering
030232 urology & nephrology
Biomedical Engineering
Vascular access
Medicine (miscellaneous)
Hemodynamics
Bioengineering
02 engineering and technology
Vascular Remodeling
Biomaterials
03 medical and health sciences
Arteriovenous Shunt
Surgical

0302 clinical medicine
Renal Dialysis
Internal medicine
medicine
Humans
Longitudinal Studies
Early failure
Aged
High rate
medicine.diagnostic_test
business.industry
Models
Cardiovascular

Settore ING-IND/34 - Bioingegneria Industriale
Magnetic resonance imaging
General Medicine
medicine.disease
020601 biomedical engineering
Arm
Hydrodynamics
Cardiology
Hemodialysis
business
Vascular Stenosis
Zdroj: The International Journal of Artificial Organs. 41:714-722
ISSN: 1724-6040
0391-3988
DOI: 10.1177/0391398818784207
Popis: Introduction: Autogenous arteriovenous fistula is the preferred vascular access for hemodialysis, but it has high rates of non-maturation and early failure due to vascular stenosis. Convincing evidence supports a key role of local hemodynamics in vascular remodeling, suggesting that unsteady and disturbed flow conditions may be related to stenosis formation in arteriovenous fistula. The purpose of our study was to explore the feasibility of coupling contrast-free magnetic resonance imaging and computational fluid dynamics in longitudinal studies to identify the role of local hemodynamic changes over time in inducing vessel wall remodeling in arteriovenous fistula. Methods: We acquired contrast-free magnetic resonance imaging of arm vasculature at 1 week and 6 weeks after arteriovenous fistula creation in a 72-year-old patient. We then generated three-dimensional models and evaluated lumen cross-sectional area of arteriovenous fistula limbs. We performed high-resolution computational fluid dynamics to evaluate changes in local hemodynamics over time. Results: Our contrast-free magnetic resonance imaging protocol provided good quality images in a short scan duration. We observed a homogeneous dilatation in the proximal artery, while there was a more pronounced lumen dilatation in the venous outflow as compared to a limited dilatation in the juxta-anastomotic vein. Furthermore, we observed a slight stabilization of the flow pattern over time, suggesting that vascular outward remodeling accommodates the flow to a more helicoidally phenotype. Conclusion: Coupling contrast-free magnetic resonance imaging and high-resolution computational fluid dynamics represents a promising approach to shed more light in the mechanisms of vascular remodeling and can be used for prospective clinical investigations aimed at identifying critical hemodynamic factors contributing to arteriovenous fistula failure.
Databáze: OpenAIRE