A computational exploration of helical arterio-venous graft designs

Although arterio-venous grafts (AVGs) are the second best option as long-term vascular access for hemodialysis, they suffer from complications caused by intimal hyperplasia, mainly located in vessel regions of low and oscillating wall shear stress. However, certain flow patterns in the bulk may reduce these unfavorable hemodynamic conditions. We therefore studied, with computational fluid dynamics (CFD), the impact of a helical AVG design on the occurrence of (un)favorable hemodynamic conditions at the venous anastomosis. Six CFD-models of an AVG in closed-loop configuration were constructed: one conventional straight graft, and five helical designed grafts with a pitch of 105 mm down to 35 mm. At the venous anastomosis, disturbed shear was assessed by quantifying the area with unfavorable conditions, and by analyzing averaged values in a case-specific patch. The bulk hemodynamics were assessed by analyzing the kinetic helicity in and the pressure drop over the graft. The most helical design scores best, being instrumental to suppress disturbed shear in the venous segment. There is, however, no trivial relationship between the number of helix turns of the graft and disturbed shear in the venous segment, when a realistic closed-loop AVG model is investigated. Bulk flow investigation showed a marked increase of helicity intensity in, and a moderate pressure drop over the AVG by introducing a lower pitch. At the venous anastomosis, unfavorable hemodynamic conditions can be reduced by introducing a helical design. However, due to the complex flow conditions, the optimal helical design for an AVG cannot be derived without studying case by case.