IMR Press / RCM / Volume 25 / Issue 1 / DOI: 10.31083/j.rcm2501035
Open Access Original Research
Computationally Enhanced, Haemodynamic Case Study of Neointimal Hyperplasia Development in a Dialysis Access Fistula
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1 Division of Surgery & Interventional Science, University College London, Royal Free Campus, NW3 2QG London, UK
2 Department of Vascular Surgery, Royal Free London NHS Foundation Trust, NW3 2QG London, UK
3 Department of Mechanical Engineering, University College London, WC1E 7JE London, UK
4 Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, W1W 7TS London, UK
*Correspondence: (Matthew Bartlett)
Rev. Cardiovasc. Med. 2024, 25(1), 35;
Submitted: 29 December 2022 | Revised: 17 November 2023 | Accepted: 21 November 2023 | Published: 22 January 2024
(This article belongs to the Special Issue New insight in Cardiovascular Imaging)
Copyright: © 2024 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Oscillatory wall shear stress and related metrics have been identified as potential predictors of dialysis access outcomes; however, the absence of a simple non-invasive method for measuring these haemodynamic forces has been prohibitive to their adoption into routine clinical practice. We present a computationally enhanced, single patient case study, offering a unique insight into the haemodynamic environment surrounding the development of flow limiting neointimal hyperplasia within the efferent vein of a previously functional arteriovenous fistula (AVF). Methods: Computational fluid dynamics (CFD) simulations were used to create a quantitative map of oscillatory shear stress as well as enabling visualisation of streamline patterns within the AVF. CFD data was compared to ultrasound-based turbulence quantification and examined alongside structural and functional changes in the access site over time. Results: This work further supports the notion that flow limiting neointimal hyperplasia development in vascular access fistulae, occurs in response to oscillatory wall shear stress, and provides proof of concept for the idea that non-invasive ultrasound turbulence quantification tools could play a role in predicting vascular access outcomes. Conclusions: In addition to providing insight into the haemodynamic environment surrounding the development of flow limiting neointimal hyperplasia, we hope that this paper will promote discussion and further thinking about how our learnings from in-silico studies can be incorporated into clinical practice through novel uses of existing diagnostic tools.

dialysis access
turbulence intensity
Fig. 1.
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