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Stenosis to stented: decrease in flow disturbances following stent implantation of a diseased arteriovenous fistula

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Abstract

The arteriovenous fistula (AVF) is commonly faced with stenosis at the juxta-anastomotic (JXA) region of the vein. Implantation of a flexible nitinol stent across the stenosed JXA has led to the retention of functioning AVFs leading to the resulting AVF geometry being distinctly altered, thereby affecting the haemodynamic environment within it. In this study, large eddy simulations of the flow field within a patient-specific AVF geometry before and after stent implantation were conducted to detail the change in flow features. Although the diseased AVF had much lower flow rates, adverse flow features, such as recirculation zones and swirling flow at the anastomosis, and jet flow at the stenosis site were present. Larger velocity fluctuations (leading to higher turbulent kinetic energy) stemming from these flow features were apparent in the diseased AVF compared to the stented AVF. The unsteadiness at the stenosis created large regions of wall shear stress (WSS) fluctuations downstream of the stenosis site that were not as apparent in the stented AVF geometry. The larger pressure drop across the diseased vein, compared to the stented vein, was primarily caused by the constriction at the stenosis, potentially causing the lower flow rate. Furthermore, the WSS fluctuations in the diseased AVF could lead to further disease progression downstream of the stenosis. The change in bulk flow unsteadiness, pressure drop, and WSS behaviour confirms that the haemodynamic environment of the diseased AVF has substantially improved following the flexible stent implantation.

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Data Availability

Original raw data are unable to be shared due to our ethics clearance; however, data post-processing algorithms are available on request.

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Acknowledgements

Sanjiv Gunasekera and Olivia Ng were recipients of the Australian Government Research Training Program Scholarship during the course of this work and gratefully acknowledge this support.

This research/project was undertaken with the assistance of resources and services from the National Computational Infrastructure (NCI), which is supported by the Australian Government.

Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, NSW, 2052, Australia

    Sanjiv Gunasekera, Charitha de Silva, Olivia Ng & Tracie Barber

  2. Department of Vascular Surgery, Prince of Wales Hospital, Randwick, NSW, 2031, Australia

    Shannon Thomas & Ramon Varcoe

Authors
  1. Sanjiv Gunasekera
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  2. Charitha de Silva
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  3. Olivia Ng
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  4. Shannon Thomas
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  5. Ramon Varcoe
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  6. Tracie Barber
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Contributions

SG, CdS, ON, ST, RV, TB were involved in conceptualisation; SG, ON, TB contributed to methodology; SG, ON were involved in data curation; SG, CdS, TB contributed to formal analysis and investigation; CdS, ST, RV, TB were involved in supervision; SG contributed to visualisation and writing—original draft; SG, CdS, ON, ST, RV, TB were involved in writing—review and editing.

Corresponding author

Correspondence to Sanjiv Gunasekera.

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Conflict of interest

Shannon Thomas reports a relationship with Abbott Vascular, Medtronic, W. L. Gore, Bio-Excel, and Shockwave that includes: consulting or advisory, funding grants, paid expert testimony, speaking and lecture fees, and travel reimbursement. Shannon Thomas is a shareholder and chief medical officer in Vexev. Ramon Varcoe reports a relationship with Abbott Vascular, Medtronic, InterVene Inc., Surmodics, Philips, BD Bard Inc., Boston Scientific, W. L. Gore, and Nectero that includes: consulting or advisory fees. Ramon Varcoe is a shareholder in EBR systems and Provision Inc. Tracie Barber reports a relationship with Abbott Vascular that includes: consulting or advisory.

Ethics approval

The patient’s data were obtained after informed consent was given under the Low/Negligible Risk (LNR) Application with the Human Research Ethics Committee number 15/063 (LNR/16/POWH/7). The ethics for the related longitudinal study was updated under the Human Research Ethics Application ID 2018/ETH00577.

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Gunasekera, S., de Silva, C., Ng, O. et al. Stenosis to stented: decrease in flow disturbances following stent implantation of a diseased arteriovenous fistula. Biomech Model Mechanobiol 23, 453–468 (2024). https://doi.org/10.1007/s10237-023-01784-5

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  • DOI: https://doi.org/10.1007/s10237-023-01784-5

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