Simulated hemodynamic comparison of arteriovenous fistulas

The hemodynamic consequences of six current types of surgically constructed arteriovenous fistulas (AVFs) in the human arm are studied with the use of the model of a stationary electric resistance circuit. Variations in arterial and venous resistances and in anastomosis techniques are considered. With this model all possible AVFs can be compared in terms of risk (loss of distal perfusion pressure) and benefit (volume of fistula flow). According to our model the most efficient type of fistula is the end-to-end AVF at the wrist. In patients with abnormally high resistance of the arm arteries this fistula is inadequate for efficient hemodialysis treatment. To reduce the incidence of finger ischemia in more proximal AVFs our model indicates that the arterial anastomosis should be as proximal as possible and/or hemodynamically nonsmooth (i.e., side-to-side).