Association of Shear Stress with Subsequent Lumen Remodeling in Hemodialysis Arteriovenous Fistulas
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Le résumé fourni par la source
BACKGROUND: Blood flow-induced wall shear stress is a strong local regulator of vascular remodeling, but its effects on arteriovenous fistula (AVF) remodeling are unclear. METHODS: In this prospective cohort study, we used computational fluid dynamics simulations and statistical mixed-effects modeling to investigate the associations between wall shear stress and AVF remodeling in 120 participants undergoing AVF creation surgery. Postoperative magnetic resonance imaging data at 1 day, 6 weeks, and 6 months were used to derive current wall shear stress by computational fluid dynamic simulations and to quantify subsequent changes in AVF lumen cross-sectional area at 1-mm intervals along the proximal artery and AVF vein. RESULTS: Combining artery and vein data, prior mean wall shear stress was significantly associated with lumen area expansion. Mean wall shear stress at day 1 was significantly associated with change in lumen area from day 1 to week 6 (11% larger area per interquartile range [IQR] higher mean wall shear stress, 95% confidence interval [95% CI], 5% to 18%; n =101), and mean wall shear stress at 6 weeks was significantly associated with change in lumen area from 6 weeks to month 6 (14% larger area per IQR higher, 95% CI, 3% to 28%; n =52). The association of mean wall shear stress at day 1 with lumen area expansion from day 1 to week 6 differed significantly by diabetes ( P =0.009): 27% (95% CI, 17% to 37%) larger area per IQR higher mean wall shear stress without diabetes and 9% (95% CI, -1% to 19%) with diabetes. Oscillatory shear index at day 1 was significantly associated with change in lumen area from day 1 to week 6 (5% smaller area per IQR higher oscillatory shear index, 95% CI, 3% to 7%), and oscillatory shear index at 6 weeks was significantly associated with change in lumen from 6 weeks to month 6 (7% smaller area per IQR higher oscillatory shear index, 95% CI, 2% to 11%). Wall shear stress spatial gradient was not significantly associated with subsequent remodeling. In a joint model, wall shear stress and oscillatory shear index statistically significantly interacted in their associations with lumen area expansion in a complex nonlinear fashion. CONCLUSIONS: Higher wall shear stress and lower oscillatory shear index were associated with greater lumen expansion after AVF creation surgery.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Association of Shear Stress with Subsequent Lumen Remodeling in Hemodialysis Arteriovenous Fistulas
- Date Crossref
- 01/01/2023
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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University of Florida Division of Vascular Surgery and Endovascular Therapy pays non établi dans la noticeUniversité ou école supérieure
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University of Utah Division of Nephrology and Hypertension pays non établi dans la noticeUniversité ou école supérieure
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VA Salt Lake City Healthcare System pays non établi dans la noticeÉtablissement de santé
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Cleveland Clinic Department of Medicine pays non établi dans la noticeÉtablissement de santé
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Cleveland Clinic Lerner College of Medicine pays non établi dans la noticeÉtablissement de santé
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Case Western Reserve University pays non établi dans la noticeUniversité ou école supérieure
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University of North Carolina at Chapel Hill Division of Nephrology and Hypertension pays non établi dans la noticeUniversité ou école supérieure
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W. G. (Bill) Hefner VA Medical Center pays non établi dans la noticeÉtablissement de santé
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Malcom Randall VA Medical Center pays non établi dans la noticeÉtablissement de santé
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Published online ahead of print. Publication date available at www.cjasn.org pays non établi dans la noticeInstitution
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Renal Section pays non établi dans la noticeInstitution
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W.G. (Bill) Hefner Veterans Affairs Medical Center Department of Medicine pays non établi dans la noticeÉtablissement de santé
Division of Vascular Surgery and Endovascular Therapy — University of Florida, Division of Nephrology and Hypertension — University of Utah et VA Salt Lake City Healthcare System, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.