Optimal anastomotic angle of end-to-side anastomosis autogenous arteriovenous fistula
10.3760/cma.j.cn121382-20241127-00109
- VernacularTitle:端侧吻合自体动静脉内瘘最佳吻合角度的研究
- Author:
Qinxian GAO
1
;
Lin MAO
;
Yangzhi LIU
;
Chengli SONG
;
Chunlai LU
;
Xiaomeng XU
;
Mingyang GUO
Author Information
1. 上海理工大学健康科学与工程学院，上海 200093
- Keywords:
End-to-side anastomosis;
Autogenous arteriovenous fistula;
Anastomosis angle;
Hemodynamics;
Numerical simulation;
Wall shear stress;
Relative residence time
- From:
International Journal of Biomedical Engineering
2025;48(1):56-61
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the optimal anastomotic angle of end-to-side anastomosis autogenous arteriovenous fistula (AVF).Methods:A case-report and case-series design was used to obtain clinical data on 10 patients with diabetic nephropathy from Department of Nephrology, the 905th Hospital of the Chinese People′s Liberation Army Navy from June 2024 to February 2025. The models of "radial artery-cephalic vein" end-to-side anastomosis in the forearm with anastomotic angles of 30°, 40°and 50°were established. Numerical simulation was used to analyze the blood flow in the model, and to study the effect of different anastomotic angles on blood flow. Wall shear stress (WSS), cross section flow velocity and flow rate, and relative residence time (RRT) were studied in the model. The Whitney test with Holm correction was used to evaluate the difference in the median RRT between the three angle models.Results:At the moment of 0.65 s, the area fraction of low wall shear stress (LWSS) in the 30° model was 7.7%, which was reduced by 2.4% and 3.7% compared to the 40°and 50°models, respectively. At the time of 0.2 s, the area proportions of high wall shear stress (HWSS) in the 30°, 40°and 50°models were 54.4%, 43.9% and 37.4%, respectively. At 0.2 s, the maximum cross section flow velocity reached 4.07, 3.84 and 3.67 m/s for the 30°, 40°and 50°models, respectively. In the cycle, the maximum mean flow velocity for the 30°model reached 1.20 m/s. The mean flow rates of the 30°, 40°and 50°models in the J-5 cross section were 349, 316, and 328 ml/min, respectivly. For patient 6, the area proportions of the RRT>1 region were 11.97%, 14.84% and 15.22% for the 30°, 40°and 50°models, respectively.Conclusions:The optimal anastomotic angle of "radial artery-cephalic vein" for end-to-side anastomosis AVF surgery in patients with diabetic nephropathy is 40°.
