Vascular Wall Vibrations in Arteriovenous Fistula; A Specific Stimulus for Stenosis Development and AVF Failure?

Abstract Hemodialysis is the lifeline for nearly three million end stage renal disease patients worldwide. Native arteriovenous fistula (AVF) is the preferred vascular access, but 40% fail within 1 year. We recently demonstrated that AVFs harbour transitional flows and the goal of the present study was to investigate whether the associated high-frequency pressure fluctuations could promote vibrations within the vascular wall. We acquired MRI images and flow rates immediately after surgery in one patient and generated a 3D patient-specific model. High-fidelity fluid structure interaction simulations revealed the presence of wall vibrations in distinct frequency bands up to 200 Hz and amplitude of 200 microns. A sensitivity analysis to assess the impact of flow rates, and vascular wall stiffness and thickness, changes that typically occur during AVF maturation, confirmed the robustness of the results. Interestingly, the vibrations were always predominant at the anastomosis floor and on the inner venous side, which correlates with typical stenotic regions. As studies seeking to correlate aberrant stresses and vascular remodelling have been largely inconclusive, the focal collocation between vibrations and stenosis may suggest an unknown mechanobiological process between high-frequency mechanical stresses within the vascular wall and adverse vascular remodelling.