功能性端侧吻合自体动静脉内瘘中的血流动力学分析
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1.克孜勒苏柯尔克孜自治州人民医院;2.苏州大学附属第一医院 克孜勒苏柯尔克孜自治州人民医院

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Analysis of hemodynamics in functional end-to-side anastomosis of autogenous arteriovenous fistula
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    摘要:

    目的:内膜增生导致的狭窄是动静脉内瘘(Arteriovenous Fistulas,AVF)失功的主要原因,既往研究认为内膜增生与AVF异常形态导致的局部血流动力学变化相关,近年认为功能性端侧吻合建立的自体动静脉内瘘可以减少内膜增生提高通畅率,本文拟从血流动力学的角度探讨功能性端侧吻合改善AVF内膜增生的可能机制。 方法:利用软件Solidworks 2018分别建立功能性端侧吻合(Side-To-End anastomosis,STE组)与常规端侧吻合法(Conventional Side-To-End anastomosis,cSTE组)动静脉内瘘模型,应用Anasys-meshing 2017进行网格划分,使用Fluent.17模拟动脉血流逆向态和顺向态下各模型的血流动力学参数:血流速度、压降、低壁面切应力区域面积(Low Wall Shear Stress Area,LWSSA)。 结果:逆向态:流速,STE组31.84cm/s,cSTE组31.76cm/s;压降,STE组-194.63Pa,cSTE组-196.62Pa,STE组总LWSSA较cSTE组下降5.70%(61.31 VS 64.91mm2),STE组有效LWSSA较cSTE组下降78.87%(3.74 VS 17.70mm2)。顺向态:流速,STE组25.74cm/s,cSTE组25.58cm/s;压降,STE组-108.02Pa,cSTE组-143.69Pa,STE组总LWSSA较cSTE组增加了6.97%(42.35 VS 39.59mm2),STE组有效LWSSA较cSTE组下降10.62%(1.01 VS 1.31mm2)。 结论:动脉血流逆向态时,功能性端侧吻合在不影响流出道血流速度的前提下可以明显改善AVF血流动力学,顺向态时功能性端侧吻合改善AVF血流动力学作用不明显。

    Abstract:

    Objectives: Stenosis caused by intimal hyperplasia is the main reason of arteriovenous fistula(AVF) dysfunction. In recent years, it is believed that AVF established by functional end-to-side anastomosis can reduce the intimal hyperplasia and improve patency rate. This paper intends to explore the possible mechanism of functional end-to-side anastomosis improving the intimal hyperplasia of AVF from the perspective of hemodynamics. Methods: AVF models of functional end-to-side anastomosis (STE) and conventional end-to-side anastomosis (cSTE) were established by SolidWorks 2018. Models were meshed by Anasys-meshing 2017. Fluent.17 was used to simulate the hemodynamics of each model with blood flow velocity, pressure drop, low wall shear stress area (LWSSA). Results:Retrograde flow: flow velocity, STE 31.84cm/s, CSTE 31.76cm/s; pressure drop, STE - 194.63pa, CSTE - 196.62pa; The total LWSSA in STE was 5.70% lower than CSTE (61.31 vs 64.91mm2); The effective LWSSA in STE was 78.87% lower than CSTE (3.74 vs 17.70mm2). Antegrade flow: flow velocity, STE 25.74cm/s, CSTE 25.58cm/s; pressure drop, STE -108.02pa, CSTE -143.69pa;The total LWSSA in STE was 6.97% greater than CSTE (42.35 vs 39.59mm2);The effective LWSSA in STE was 10.62% lower than CSTE (1.01 vs 1.31mm2). Conclusions: In retrograde flow state, functional end-to-side anastomosis can significantly improve the hemodynamics of AVF without affecting the flow velocity of outflow tract, while in antegrade flow state, functional end-to-side anastomosis has no significant effect on the hemodynamics of AVF.

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  • 收稿日期:2021-02-08
  • 最后修改日期:2021-05-19
  • 录用日期:2021-05-20
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