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

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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.

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 4150 Clement Street, Box 411D, San Francisco, 94121, CA, USA

    Monica Sigovan, Vitaliy Rayz & David Saloner

  2. Department of Vascular Surgery, University of California, San Francisco, CA, USA

    Warren Gasper, Hugh F. Alley & Christopher D. Owens

  3. Vascular Surgery Service, VA Medical Center, San Francisco, CA, USA

    Christopher D. Owens

  4. Radiology Service, VA Medical Center, San Francisco, CA, USA

    David Saloner

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  1. Monica Sigovan
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  2. Vitaliy Rayz
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Correspondence to Monica Sigovan.

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Associate Editor Scott I Simon oversaw the review of this article.

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Sigovan, M., Rayz, V., Gasper, W. et al. Vascular Remodeling in Autogenous Arterio-Venous Fistulas by MRI and CFD. Ann Biomed Eng 41, 657–668 (2013). https://doi.org/10.1007/s10439-012-0703-4

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  • DOI: https://doi.org/10.1007/s10439-012-0703-4

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