@article{TEXTUAL,
      recid = {7209},
      author = {Hammes, Mary and Boghosian, Michael and Cassel, Kevin and  Watson, Sydeaka and Funaki, Brian and Doshi, Taral and  Mahmoudzadeh Akherat, S. M. Javid and Hines, Jane and Coe,  Fredric},
      title = {Increased Inlet Blood Flow Velocity Predicts Low Wall  Shear Stress in the Cephalic Arch of Patients with  Brachiocephalic Fistula Access},
      journal = {PLOS ONE},
      address = {2016-04-13},
      number = {TEXTUAL},
      abstract = {&lt;p&gt;Background: An autogenous arteriovenous fistula is the  optimal vascular access for hemodialysis. In the case of  brachiocephalic fistula, cephalic arch stenosis commonly  develops leading to access failure. We have hypothesized  that a contribution to fistula failure is low wall shear  stress resulting from post-fistula creation hemodynamic  changes that occur in the cephalic arch.&lt;/p&gt; &lt;p&gt;Methods:  Twenty-two subjects with advanced renal failure had  brachiocephalic fistulae placed. The following procedures  were performed at mapping (pre-operative) and at fistula  maturation (8–32 weeks post-operative): venogram, Doppler  to measure venous blood flow velocity, and whole blood  viscosity. Geometric and computational modeling was  performed to determine wall shear stress and other  geometric parameters. The relationship between hemodynamic  parameters and clinical findings was examined using  univariate analysis and linear regression.&lt;/p&gt; &lt;p&gt;Results:  The percent low wall shear stress was linearly related to  the increase in blood flow velocity (p &lt; 0.01). This  relationship was more significant in non-diabetic patients  (p &lt; 0.01) than diabetic patients. The change in global  measures of arch curvature and asymmetry also evolve with  time to maturation (p &lt; 0.05).&lt;/p&gt; &lt;p&gt;Conclusions: The  curvature and hemodynamic changes during fistula maturation  increase the percentage of low wall shear stress regions  within the cephalic arch. Low wall shear stress may  contribute to subsequent neointimal hyperplasia and  resultant cephalic arch stenosis. If this hypothesis  remains tenable with further studies, ways of protecting  the arch through control of blood flow velocity may need to  be developed.&lt;/p&gt;},
      url = {http://knowledge.uchicago.edu/record/7209},
}