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  • Haemodynamics and vascular remodeling in vascular access : insights from numerical studies Citation for published version (APA): Ene-Iiordache, B. (2015). Haemodynamics and vascular remodeling in vascular access : insights from numerical studies. Eindhoven: Technische Universiteit Eindhoven.

    Document status and date: Published: 01/01/2015

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    Download date: 07. Jun. 2020

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  • Haemodynamics and Vascular Remodeling in Vascular Access

    Insights from Numerical Studies

    Bogdan Ene-Iordache

  • Haemodynamics and Vascular Remodeling in Vascular Access

    Insights from Numerical Studies

  • A catalogue record is available from the Eindhoven University of Technology Library. ISBN: 978-90-386-3906-2 Cover design: Davide Martinetti, Mario Negri Institute for Pharmacological Research, Ranica, Italy. Printed by: Cartolibreria Snoopy (www.cartolibreriasnoopy.it), Brescia, Italy. Financial support by the European Commission within the Seventh Framework Programme (ICT-2007-224390-ARCH) is gratefully acknowledged. Additional financial support was generously provided by Fondazione A.R.M.R., Bergamo, Italy. © 2015 B. Ene-Iordache, Ranica, Italy All rights reserved. No part of this book may be reproduced or transmitted in any form by any means, without prior written permission from the copyright owner.

    http://www.cartolibreriasnoopy./

  • Haemodynamics and Vascular Remodeling in Vascular Access

    Insights from Numerical Studies

    PROEFSCHRIFT ter verkrijging van de graad van doctor aan de Technische Universiteit

    Eindhoven, op gezag van de rector magnificus prof.dr.ir. F.P.T. Baaijens, voor een commissie aangewezen door het College voor Promoties, in het

    openbaar te verdedigen op maandag 7 september 2015 om 14:00 uur

    door

    Bogdan Ene-Iordache

    geboren te Ploiesti, Roemenië

  • Dit proefschrift van het proefontwerp is goedgekeurd door de promotoren en de samenstelling van de promotiecommissie is als volgt: voorzitter: prof.dr. P.A.J. Hilbers 1e promotor: prof.dr.ir. F.N. van de Vosse 2e promotor: prof.dr. A. Remuzzi (University of Bergamo) leden: prof.dr.ir. F.P.T. Baaijens prof.dr. G. Dubini (Polytechnic University of Milan) prof.dr. T. Delhaas (UM) dr. J.H.M. Tordoir (UM-MUMC) prof.dr.ir. P.D. Anderson

  • To my father

  • Table of Contents

    LIST OF ABBREVIATIONS ..................................................................................................................... 3

    CHAPTER 1 General Introduction ........................................................................................................... 5 1.1. Motivation ......................................................................................................................................... 6 1.2. Clinical background .......................................................................................................................... 7

    1.2.1. Haemodialysis ........................................................................................................................... 7 1.2.2. The vascular access for haemodialysis .................................................................................... 8

    1.2.2.1. Permanent vascular access............................................................................................... 8 1.2.2.2. Haemodynamics of vascular access ............................................................................... 10 1.2.2.3. Complications of vascular access ................................................................................... 11

    1.3. The role of haemodynamics in vascular remodeling and disease ................................................. 13 1.3.1. Haemodynamic stimuli ............................................................................................................ 13

    1.3.1.1. Haemodynamic pressure ................................................................................................. 13 1.3.1.2. Haemodynamic shear stress ........................................................................................... 14 1.3.1.3. Mechanisms of blood vessel remodeling ......................................................................... 14

    1.3.2. The response of endothelium to shear forces......................................................................... 15 1.3.3. Intimal hyperplasia .................................................................................................................. 17

    1.4. Study objectives ............................................................................................................................. 19 1.4.1. Unmet questions in AVF ......................................................................................................... 19 1.4.2. Aim of the dissertation ............................................................................................................. 19 1.4.3. Thesis outline .......................................................................................................................... 20

    1.5. References ..................................................................................................................................... 23

    CHAPTER 2 Disturbed flow in radial-cephalic arteriovenous fistulae for haemodialysis ...................... 27 2.1. Abstract .......................................................................................................................................... 28 2.2. Introduction ..................................................................................................................................... 29 2.3. Methods .......................................................................................................................................... 32

    2.3.1 Three-dimensional models of the AVF ..................................................................................... 32 2.3.2. Numerical simulations of blood flow in the AVF ...................................................................... 34

    2.4. Results ............................................................................................................................................ 37 2.4.1. Flow patterns in the AVF ......................................................................................................... 37 2.4.2. WSS patterns in the AVF ........................................................................................................ 38 2.4.3. OSI and RRT in the AVF ......................................................................................................... 40

    2.5. Discussion ...................................................................................................................................... 43 2.6. Acknowledgments .......................................................................................................................... 49 2.7. References ..................................................................................................................................... 50

    CHAPTER 3 The anastomosis angle does change disturbed flow patterns in side-to-end fistulae for haemodialysis ........................................................................................................................................ 53 3.1. Abstract .....................................