Background: The current gold standard for End-Stage Renal Disease (ESRD) patients undergoing dialysis is creating an arteriovenous fistula (AVF) that allows a mature vein to withstand the vagaries of dialysis. Unfortunately, ESRD patients undergoing dialysis suffer AVF thrombosis, primarily in the cephalic vein arch.

Aims: We aim to understand why cephalic arch thrombosis occurs in ESRD
patients through computational and experimental exploration of the complex interplay between abnormal hemodynamics, patient-specific vein geometry and biochemical factors that lead to endothelial cell activation.

Methods: We present personalized 3D millifluidic models of ESRD patients’ cephalic arches at 3 and 12 months post AVF creation. These 3D models were created utilizing patient-specific Intravascular Ultrasound and venogram images that were coupled via SOLIDWORKS and AutoCAD. The patient-specific computational models were subjected to 1) Computational Fluid Dynamics simulations and 2) fabrication of fluidic devices in order to assess hemodynamics. These models were perfused with blood mimicking fluid containing fluorescent tracer beads at healthy (baseline) and patient-specific cephalic vein flow rates, measured 3 and 12 months after AVF creation (using Doppler measurements).

Results: Particle image velocity was used to calculate Reynolds number and local wall shear stress in the cephalic arch. We were able to visualize recirculation pools and calculate turbulent flow conditions across the cephalic arch.

Conclusions: Future patient-specific hemodynamic analyses using blood from patients and healthy donors, with and without the presence of clotting factors and anti-coagulants will permit
identification of key parameters and regimes that correlate with thrombotic events. These fluidic devices allow isolating each contributing factor- geometry, flow dynamics, and biochemical factors- to understand their individual contribution in thrombosis. Elucidating the parameters of thrombogenesis in ESRD will enable more efficient and personalized treatments to maintain access and prevent complications during dialysis.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/developing-fluidic-models-that-replicate-cephalic-arch-geometry-and-flow-conditions-of-dialysis-patients-to-understand-and-predict-access-thrombosis/