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A Vein Attempt? Experimental Models for Arteriovenous Fistula Research
Nasir A Shah1,2, Calvin D Li3, Shannon D Thomas3,4
1School of Clinical Medicine, Faculty of Medicine & Health, UNSW Sydney, Sydney, NSW, Australia. nasir.a.shah@unsw.edu.au.
Cardiovascular Engineering and Technology
|May 7, 2026
Summary
Arteriovenous fistula (AVF) maturation and failure are complex processes involving biomechanical and biological factors. Understanding these interactions requires integrating multiple experimental models for improved vascular access outcomes.
Area of Science:
- Biomedical Engineering
- Vascular Biology
- Nephrology
Background:
- Chronic kidney disease (CKD) affects over 10% of the global population, increasing the need for hemodialysis.
- Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis but frequently fail to mature or experience complications.
- Current understanding of AVF maturation and failure mechanisms is limited, hindering the development of effective interventions.
Purpose of the Study:
- To review and compare experimental models used to study arteriovenous fistula (AVF) maturation and failure.
- To analyze the strengths, limitations, and complementary roles of animal models, computational approaches, and in vitro systems in vascular access research.
- To highlight the need for a multimodal framework integrating diverse experimental platforms.
Main Methods:
- Comprehensive literature review of experimental models for AVF research.
- Analysis of animal models, computational fluid dynamics (CFD), fluid-structure interaction (FSI) simulations, conventional in vitro systems, and microfluidic/macrofluidic devices.
- Comparative assessment of model fidelity, scalability, throughput, and translational relevance.
Main Results:
- AVF maturation is governed by hemodynamic changes (shear stress, pressure, strain) and biological responses within a uremic environment.
- Existing experimental models capture specific dimensions of AVF biology but have inherent trade-offs.
- No single model fully replicates the complexity of AVF maturation and failure.
Conclusions:
- AVF maturation and failure result from intricate biomechanical and biological interactions influenced by hemodynamics and uremia.
- A multimodal research framework integrating animal studies, computational simulations, and in vitro systems is crucial for progress.
- Such an integrated approach is essential for identifying biomarkers, elucidating maladaptive remodeling, and designing interventions to improve AVF patency.
