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Critical Reviews™ in Biomedical Engineering

年間 6 号発行

ISSN 印刷: 0278-940X

ISSN オンライン: 1943-619X

SJR: 0.262 SNIP: 0.372 CiteScore™:: 2.2 H-Index: 56

Indexed in

Computational Analyses and Design Improvements of Graft-to-Vein Anastomoses

巻 28, 発行 1&2, 2000, pp. 141-147
DOI: 10.1615/CritRevBiomedEng.v28.i12.240
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要約

For hemodialysis patients, arteriovenous grafts are omnipresent. Unfortunately, a large percentage of such grafts fail within the first year after surgery because of occlusive lesions mainly at the venous anastomotic site. It is textbook knowledge that critical values of certain hemodynamic parameters, such as low (oscillatory) wall shear stresses, large sustained wall shear stress gradients, significant changes in wall shear stress angles, excessive radial pressure gradients, etc., play significant roles in the onset and/or development of vascular diseases. The idea is to geometrically design graft-to-vein configurations such that aggravating flow patterns are reduced, and hence stenotic developments are minimized.
Focusing on a new blood rheological model in conjunction with three graft-to-vein anastomotic configurations, that is, a base case, the Bard-IMPRA VenafloTM graft, and a new graft-end design, the corresponding transient laminar 3-D hemodynamics are numerically simulated and compared. The design criterion for the best performance of these junction geometries is the most significant reduction in locally disturbed flow as expressed by equally weighted indicator functions for the onset and progression of stenotic developments. As a result of this comparison study, quantitative recommendations for arteriovenous loop graft designs toward increased patency rates are provided. The resulting improved graft design will be scrutinized in clinical trials.

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  1. Roy-Chaudhury Prabir, El-Khatib Mahmoud, Campos-Naciff Begona, Wadehra Davinder, Ramani Karthik, Leesar Massoud, Mistry Meenakshi, Wang Yang, Chan Jenq-Shyong, Lee Timmy, Munda Rino, Back to the Future: How Biology and Technology Could Change the Role of PTFE Grafts in Vascular Access Management, Seminars in Dialysis, 25, 5, 2012. Crossref

  2. Longest P. Worth, Kleinstreuer Clement, Deanda Abe, Numerical Simulation of Wall Shear Stress and Particle-Based Hemodynamic Parameters in Pre-Cuffed and Streamlined End-to-Side Anastomoses, Annals of Biomedical Engineering, 33, 12, 2005. Crossref

  3. Liu Yun-Hen, Hung Yen-Ni, Hsieh Hung-Chang, Ko Po-Jen, Impact of Cuffed, Expanded Polytetrafluoroethylene Dialysis Grafts on Graft Outlet Stenosis, World Journal of Surgery, 30, 12, 2006. Crossref

  4. Heise M., Schmidt S., Krüger U., Pfitzmann R., Scholz H., Neuhaus P., Settmacher U., Local Haemodynamics and Shear Stress in Cuffed and Straight PTFE-venous Anastomoses: An in-vitro Comparison using Particle Image Velocimetry, European Journal of Vascular and Endovascular Surgery, 26, 4, 2003. Crossref

  5. Sorom Abraham J., Hughes Christopher B., McCarthy James T., Jenson Bernice M., Prieto Mikel, Panneton Jean M., Sterioff Sylvester, Stegall Mark D., Nyberg Scott L., Prospective, randomized evaluation of a cuffed expanded polytetrafluoroethylene graft for hemodialysis vascular access, Surgery, 132, 2, 2002. Crossref

  6. Hund S J, Antaki J F, An extended convection diffusion model for red blood cell-enhanced transport of thrombocytes and leukocytes, Physics in Medicine and Biology, 54, 20, 2009. Crossref

  7. Ko Po-Jen, Liu Yun-Hen, Hung Yen-Ni, Hsieh Hung-Chang, Patency Rates of Cuffed and Noncuffed Extended Polytetrafluoroethylene Grafts in Dialysis Access: A Prospective, Randomized Study, World Journal of Surgery, 33, 4, 2009. Crossref

  8. Roy-Chaudhury Prabir, Lee Timmy C, Vascular stenosis: biology and interventions, Current Opinion in Nephrology and Hypertension, 16, 6, 2007. Crossref

  9. Heise Michael, Husmann Inga, Grüneberg Ann-Kathrin, Knobel Alexander, Kirschner Petra, Heidenhain Christoph, Comparison of straight and Venaflo-type cuffed arteriovenous ePTFE grafts in an animal study, Journal of Vascular Surgery, 53, 6, 2011. Crossref

  10. Misra Sanjay, Lee Nathan, Fu Alex A., Raghavakaimal Sreekumar, Mandrekar Jaywant, Bjarnason Haraldur, McKusick Michael A., Iruela-Arispe Luisa, Mukhopadhyay Debabrata, Increased Expression of A Disintegrin and Metalloproteinase Thrombospondin–1 in Thrombosed Hemodialysis Grafts, Journal of Vascular and Interventional Radiology, 19, 1, 2008. Crossref

  11. Misra Sanjay, Fu Alex A., Misra Khamal D., Glockner James F., Mukhopadhyay Debabrata, Wall Shear Stress Measurement Using Phase Contrast Magnetic Resonance Imaging with Phase Contrast Magnetic Resonance Angiography in Arteriovenous Polytetrafluoroethylene Grafts, Angiology, 60, 4, 2009. Crossref

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