Computational modeling of the cephalic arch with jugulocephalic vein variant predicts hemodynamic profiles in patients with brachiocephalic fistula
, 2, 3, 4, 5, 3, 4, 4, 1
Abstract
Background: The cephalic vein is often used in for arteriovenous fistula creation; however, the cephalic vein variation is common. This study will propose new theoretical explanations for a new discovered variation of cephalic vein draining into external jugular vein with “T-junction” shape by means of 3D computational hemodynamic modeling, which may provide reference for clinical practice.
Methods: The precise measurements were conducted for the variant right cephalic vein draining into external jugular vein and for a normal right cephalic vein as a control. After processing the anatomical data, 3D geometrical model was reconstructed. Then, the influent field inside the variant jugulocephalic vein was mathematically modeled to get a detailed description of hemodynamic environment.
Results: The anatomical parameters of the “T-junction” jugulocephalic vein variant were much more different from the normal right cephalic vein. The wall shear stress of variant cephalic vein at the corresponding position was higher and changed more rapidly than that of normal cephalic vein. The shear rate contour lines are disordered in several areas of the variant cephalic vein, indicating that the hemodynamic parameters in these areas are unstable. The hemodynamic characteristics at the confluence of the variant cephalic vein are more complex, with more areas where hemodynamic parameters are disrupted.
Conclusions: The variation of cephalic arch in a “T-junction” with external jugular vein largely altered the fluid dynamics, especially in hemodialysis patients with brachiocephalic fistula in terms of the simulating flow in 3D computational model. This computational model provides hemodynamic profiles for stabilizing or modulating fluid dynamics in patients with jugulocephalic vein variant after brachiocephalic fistula.
Keywords: computational modelingjugulocephalic vein variantcephalic archbrachiocephalic fistulahemodynamics
References
- Alam N, Walsh M, Newport D. Experimental evaluation of a patient specific Brachio-Cephalic Arterio Venous Fistula (AVF): Velocity flow conditions under steady and pulsatile waveforms. Med Eng Phys. 2022; 106: 103834.
- Araújo RC, Pires LAS, Andrade ML, et al. Embryological and comparative description of the cephalic vein joining the external jugular vein: A case report. Morphologie. 2018; 102(336): 44–47.
- Bai H, Sadaghianloo N, Gorecka J, et al. Artery to vein configuration of arteriovenous fistula improves hemodynamics to increase maturation and patency. Sci Transl Med. 2020; 12(557).
- Beathard GA, Jennings WC, Wasse H, et al. ASDIN white paper: Management of cephalic arch stenosis endorsed by the American Society of Diagnostic and Interventional Nephrology. J Vasc Access. 2023; 24(3): 358–369.
- Hammes M, Boghosian M, Cassel K, et al. Hemodynamics in the cephalic arch of a brachiocephalic fistula. Med Eng Phys. 2014; 36(7): 822–830.
- Colley E, Simmons A, Varcoe R, et al. Arteriovenous fistula maturation and the influence of fluid dynamics. Proc Inst Mech Eng H. 2020; 234(11): 1197–1208.
- Corretti MC, Anderson TJ, Benjamin EJ, et al. International Brachial Artery Reactivity Task Force. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002; 39(2): 257–265.
- Ene-Iordache B, Mosconi L, Remuzzi G, et al. Computational fluid dynamics of a vascular access case for hemodialysis. J Biomech Eng. 2001; 123(3): 284–292.
- Franco G, Mallios A, Bourquelot P, et al. Ultrasound evaluation of percutaneously created arteriovenous fistulae between radial artery and perforating vein at the elbow. J Vasc Access. 2020; 21(5): 694–700.
- Hammes M, Moya-Rodriguez A, Bernstein C, et al. Computational modeling of the cephalic arch predicts hemodynamic profiles in patients with brachiocephalic fistula access receiving hemodialysis. PLoS One. 2021; 16(7): e0254016.
- Jun ES, Lun AL, Nikam M. A rare anatomic variant of a single-conduit supraclavicular cephalic arch draining into the external jugular vein presenting with recurrent arteriovenous fistula stenosis in a hemodialysis patient. J Vasc Surg Cases Innov Tech. 2017; 3(1): 20–22.
- Kameda S, Tanaka O, Terayama H, et al. Variations of the cephalic vein anterior to the clavicle in humans. Folia Morphol. 2018; 77(4): 677–682.
- Kim HK, Han A, Ahn S, et al. Better Efficacy of Balloon Assisted Maturation in Radial-Cephalic Arteriovenous Fistula for Hemodialysis. Vasc Specialist Int. 2021; 37(1): 29–36.
- Lee HN, Yang SB, Lee WH, et al. Prevalence and clinical significance of anatomic variant in cephalic arch on preoperative mapping venography. Sci Rep. 2022; 12(1): 17398.
- Moya-Rodríguez A, Xie B, Cook D, et al. Creating patient-specific vein models to characterize wall shear stress in hemodialysis population. Comput Struct Biotechnol J. 2022; 20: 5729–5739.
- Pirozzi N, Mancianti N, Scrivano J, et al. Monitoring the patient following radio-cephalic arteriovenous fistula creation: current perspectives. Vasc Health Risk Manag. 2021; 17: 111–121.
- Prouse G, Stella S, Vergara C, et al. Computational analysis of turbulent hemodynamics in radiocephalic arteriovenous fistulas to determine the best anastomotic angles. Ann Vasc Surg. 2020; 68: 451–459.
- Remuzzi A, Ene-Iordache B, Mosconi L, et al. Radial artery wall shear stress evaluation in patients with arteriovenous fistula for hemodialysis access. Biorheology. 2003; 40(1-3): 423–430.
- Soliveri L, Bozzetto M, Brambilla P, et al. Hemodynamics in AVF over time: A protective role of vascular remodeling toward flow stabilization. Int J Artif Organs. 2023; 46(10-11): 547–554.
- Xiao Y, Martinez L, Zigmond Z, et al. Functions for platelet factor 4 (PF4/CXCL4) and its receptors in fibroblast-myofibroblast transition and fibrotic failure of arteriovenous fistulas (AVFs). J Vasc Access. 2023 [Epub ahead of print]: 11297298231192386.
- Yang CY, Li MC, Lan CW, et al. The Anastomotic Angle of Hemodialysis Arteriovenous Fistula Is Associated With Flow Disturbance at the Venous Stenosis Location on Angiography. Front Bioeng Biotechnol. 2020; 8: 846.
- Yun SS, Mok S, Park SC, et al. Efficacy of blood flow measurement using intraoperative color flow Doppler ultrasound as a predictor of autologous arteriovenous fistula maturation. Ther Apher Dial. 2023; 27(1): 50–58.
- Zhu Yu, Xu XY, Mason J, et al. Irregular anatomical features can alter hemodynamics in Takayasu arteritis. JVS Vasc Sci. 2023; 4: 100125.
