Shuntchirurgie und Hämodynamik

Arteriovenous fistula (AVF), a surgically created connection between a vein and an artery in the arm, is the preferred vascular access for hemodialysis. The hemodynamic changes induced by AVF surgical creation lead to vascular remodeling during the maturation phase, involving vein dilation, wall thickening, and increased blood flow rate. This adaptive process is crucial for the arterialization of venous limb, allowing the need cannulation and obtaining sufficient blood flow for effective hemodialysis. However, many AVFs fail to mature or experience complications over time, such as stenosis, thrombosis, leading to loss of patency. The AVF failure rate remains high. In the last decades, several studies have investigated the hemodynamics within AVFs to understand the relationship between turbulent-like flow detected in the AVF vein and adverse vascular remodeling. Abnormal wall stress (WS) has been the primary focus, because WS-based indicators have been proposed to correlate with AVF failure. Additionally, AVF geometry, anastomotic length and angle have been studied as contributing factors to AVF failure. This chapter presents the state-of-the-art research on AVF hemodynamics and its implications in vascular remodelling.