功能性端侧吻合自体动静脉内瘘中的血流动力学分析

目的 应用计算流体动力学(computational fluid dynamics, CFD)方法探索功能性端侧吻合自体动静脉内瘘(arteriovenous fistulas, AVF)中的血流动力学特征，为AVF的临床应用提供理论依据。方法 建立功能性端侧吻合(STE组)与常规端侧吻合法(cSTE组)AVF模型。分析远端动脉血流逆向与顺向两种情况下各组模型的血流动力学参数，包括血流速度、压降、低壁面切应力区域面积(low wall shear stress area, LWSSA)。结果 远端动脉血流逆向时，STE组总LWSSA较cSTE组下降5.70%,STE组静脉壁LWSSA较cSTE组下降49.71%。远端动脉血流顺向时，STE组总LWSSA较cSTE组增加6.97%,STE组静脉壁LWSSA较cSTE组下降10.62%。结论 远端动脉血流逆向时，功能性端侧吻合可以明显减少AVF的LWSSA;顺向时，功能性端侧吻合对LWSSA的改善作用不明显。

Hemodynamic Analysis on Functional End-to-Side Anastomosis of Autogenous Arteriovenous Fistula

Objective To explore the hemodynamic characteristics in functional side-to-end (STE) anastomosis arteriovenous fistula (AVF) by computational fluid dynamics (CFD), so as to provide theoretical basis for clinical application of the AVF. Methods AVF models of functional STE anastomosis (STE group) and conventional STE anastomosis (cSTE group) were established. The hemodynamic parameters of models in two groups under retrograde and antegrade flow states were analyzed, including blood flow velocity, pressure drop, low wall shear stress area (LWSSA). Results Under retrograde flow, the total LWSSA in STE group was 5.70% lower than that in cSTE group, and the LWSSA on venous wall in STE group was 49.71% lower than that in cSTE group. Under antegrade flow, the total LWSSA in STE group was 6.97% greater than that in cSTE group, and the LWSSA on venous wall in STE group was 10.62% lower than that in cSTE group. Conclusions Under retrograde flow state, functional STE anastomosis can significantly decrease the LWSSA of AVF, while under antegrade flwo state, functional STE anastomosis has no significant impact on improving the LWSSA of AVF.