Development of a predictne framework to forecast venous stenosis

Abstract

The end stage renal disease (ESRD) patient population is growing at a troubling rate, calling for a focused attention to investigate the chronic kidney diseases, their characteristics and our lines of defense against them. One major medical treatment for ESRD patients is hemodialysis which is facilitated through vascular access (VA). The vascular access of particular interest in this investigation as well as the med- ical community is the brachiocephalic fistula (BCF), which is a form of arteriovenous fistula (AVF), created surgically by connecting the brachial artery and the cephalic vein. It is commonly used for elderly patients and for those with poor circulation systems, e.g. diabetics. The extreme hemodynamic environment that BCF creates triggers the onset of neointimal hyperplasia (NH) in most of these patients which leads to access failure and a high morbidity and mortality rate. This process happens in a matter of months, providing an excellent translational medicine experimental stage to observe as the vessel walls react and adapt to the new hemodynamically violent conditions. Through extensive analysis of the venous deformation and subsequent hemodynamics of a patient cohort of 160, a prognosticative framework to predict the vein deformation in these patients prior to the occurrence of the failure has been developed. The obtained results are the consequence of the integration of clinical practice and computational science. The proposed method was first based on our hypothesis which roots the NH in non-physiological wall shear stresses (WSS), and was then improved and modified using rigorous optimization and numerical approaches. This finding is essential to the modification of the current VA techniques to increase the patency of the AVFs, to prevent the diminishing functionality of the access, and to increase the life expectancy of ESRD patients. Moreover, this finding will further assist us in comprehension of the human vasculature growth and remodeling (G&R;) through bypassing the analysis of unknown biological phenomena, as it is achieved purely by juxtaposing well-defined mathematical, physical, and medical concepts