Optimizing venous anastomosis angle for arteriovenous graft with intimal hyperplasia using computational fluid dynamics

Vascular access (VA), a renal failure therapy, is often performed using an arteriovenous (AV) graft for patients with veins and arteries that cannot be connected with autologous blood vessels. However, VA using AV grafts can change the blood flow and lead to intimal hyperplasia (IH), causing the damage on blood vessel and failure of VA. In our study, we investigated the effect of the anastomosis angle on blood vessel damage under various IH formation conditions. We simulated the blood flow near the anastomosis between vein and AV graft and quantitatively evaluated the blood vessel damage using hemodynamic factors, such as wall shear stress (WSS). Our results show that smaller anastomosis angle reduces damage to blood vessels and prevents IH formation and growth regardless of IH progression, shape, and position. These results can contribute to optimization of the anastomosis angle during VA surgery to improve a patient’s prognosis.