TY - JOUR
T1 - Towards the Identification of Hemodynamic Parameters Involved in Arteriovenous Fistula Maturation and Failure
T2 - A Review
AU - Franzoni, Marco
AU - Walsh, Michael T.
N1 - Publisher Copyright:
© 2017, Biomedical Engineering Society.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Native arteriovenous fistulas have a high failure rate mainly due to the lack of maturation and uncontrolled neo-intimal hyperplasia development. Newly established hemodynamics is thought to be central in driving the fistula fate, after surgical creation. To investigate the effects of realistic wall shear stress stimuli on endothelial cells, an in vitro approach is necessary in order to reduce the complexity of the in vivo environment. After a systematic review, realistic WSS waveforms were selected and analysed in terms of magnitude, temporal gradient, presence of reversing phases (oscillatory shear index, OSI) and frequency content (hemodynamics index, HI). The effects induced by these waveforms in cellular cultures were also considered, together with the materials and methods used to cultivate and expose cells to WSS stimuli. The results show a wide heterogeneity of experimental approaches and WSS waveform features that prevent a complete understanding of the mechanisms that regulate mechanotransduction. Furthermore, the hemodynamics derived from the carotid bifurcation is the most investigated (in vitro), while the AVF scenario remains poorly addressed. In conclusion, standardisation of the materials and methods employed, as well as the decomposition of realistic WSS profiles, are required for a better understanding of the hemodynamic effects on AVF outcomes. This standardisation may also lead to a new classification of WSS features according to the risk associated with vascular dysfunction.
AB - Native arteriovenous fistulas have a high failure rate mainly due to the lack of maturation and uncontrolled neo-intimal hyperplasia development. Newly established hemodynamics is thought to be central in driving the fistula fate, after surgical creation. To investigate the effects of realistic wall shear stress stimuli on endothelial cells, an in vitro approach is necessary in order to reduce the complexity of the in vivo environment. After a systematic review, realistic WSS waveforms were selected and analysed in terms of magnitude, temporal gradient, presence of reversing phases (oscillatory shear index, OSI) and frequency content (hemodynamics index, HI). The effects induced by these waveforms in cellular cultures were also considered, together with the materials and methods used to cultivate and expose cells to WSS stimuli. The results show a wide heterogeneity of experimental approaches and WSS waveform features that prevent a complete understanding of the mechanisms that regulate mechanotransduction. Furthermore, the hemodynamics derived from the carotid bifurcation is the most investigated (in vitro), while the AVF scenario remains poorly addressed. In conclusion, standardisation of the materials and methods employed, as well as the decomposition of realistic WSS profiles, are required for a better understanding of the hemodynamic effects on AVF outcomes. This standardisation may also lead to a new classification of WSS features according to the risk associated with vascular dysfunction.
KW - Arteriovenous fistula
KW - Cone-and-plate
KW - Hemodynamics index
KW - Oscillatory shear index
KW - Temporal wall shear stress gradient
KW - Wall shear stress
UR - http://www.scopus.com/inward/record.url?scp=85028414272&partnerID=8YFLogxK
U2 - 10.1007/s13239-017-0322-1
DO - 10.1007/s13239-017-0322-1
M3 - Article
C2 - 28744783
AN - SCOPUS:85028414272
SN - 1869-408X
VL - 8
SP - 342
EP - 356
JO - Cardiovascular Engineering and Technology
JF - Cardiovascular Engineering and Technology
IS - 3
ER -