Creating Patient-Specific Vein Models for Hemodynamic Characterization in Hemodialysis Population

Up to 70% of End-Stage Renal Disease hemodialysis patients receiving treatment by means of an arteriovenous fistula (AVF) suffer from AVF thrombosis, primarily in the cephalic vein arch. This greatly contributes to morbidity and mortality in an already vulnerable population. Understanding the exact mechanism of thrombosis in these patients has proved challenging due to the complex interplay between contributing factors: abnormal hemodynamics, patient-specific vein geometry and biochemical factors that lead to coagulation. We present personalized 3D fluidic models of the cephalic arch of dialysis patients at 3 and 12 months after surgical creation of the AVF. Computational 3D models are created from patient-specific Intravascular Ultrasound and venogram imaging data. These models are then explored using Computational Fluid Dynamics simulations and fabricating fluidic devices to simulate physiologic flow. Fluorescent beads added to a blood-mimicking fluid allow us to calculate Reynolds number and local Wall Shear Stress across the cephalic arch. Comparative analysis of these parameters will allow us to elucidate the interplay between vein geometry and flow. Elucidating the parameters of thrombogenesis in these patients will enable more efficient and personalized treatments to maintain AVF access and prevent complications during hemodialysis.