1 / 20

Doran Mix 1 Joseph Featherall 2 University of Rochester School of Medicine and Dentistry 1

Pulsatile Hemodynamic Circuit Simulation of Access-Related Distal Ischemia and a Potential Mechanism for the Distal Revascularization-Interval Ligation Corrective Procedure. Doran Mix 1 Joseph Featherall 2 University of Rochester School of Medicine and Dentistry 1

armine
Télécharger la présentation

Doran Mix 1 Joseph Featherall 2 University of Rochester School of Medicine and Dentistry 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Pulsatile Hemodynamic Circuit Simulation of Access-Related Distal Ischemia and a Potential Mechanism for the Distal Revascularization-Interval Ligation Corrective Procedure Doran Mix1 Joseph Featherall2 University of Rochester School of Medicine and Dentistry1 Rochester Institute of Technology2

  2. Disclosure: • None

  3. Objectives: • Model physiologic pulsatile blood flow in a Brachial-Cephalic arterovenous fistula • Observe retrograde blood flow in the arterial segment distal to AVF as a surrogate of access related distal ischemia (ARI) • Observe effect of capacitance and resistance produced by the Distal Revascularization-Interval Ligation procedure (DRIL)

  4. Hypothesis: • Pulsatile retrograde blood flow in the arterial segment distal to the AVF is a function of arterial collateral resistance and capacitance. • Distal Revascularization will promote retrograde blood flow to the distal limb by decreasing collateral resistance and increasing capacitance. • Interval Ligation is needed to prevent retrograde blood flow.

  5. Clinical Application • May 2009: 179,113 patients used AVF for hemodialysis • 52.6% of RRT population • Rate of Distal Ischemia after fistula creation ~1.6-8% • Future reimbursement based on outcomes

  6. Limitations: • Retrograde blood flow in the arterial segment distal to the AVF is neither necessary nor sufficient for ARI.

  7. Method: • Convert pulsatile arterial blood flow into an electric circuit diagram of an upper arm AVF • Pressure  Voltage • Flow  Current • Vessel Radius and Length  Resistance • Vessel Volume  Capacitance • Fluid Inertia  Inductance • Change resistance and capacitance of collaters • Hemodynamics in segment distal to AVF

  8. Arterial Windkessel Model

  9. Bridge: Hemodynamic  Circuit Ohms Law: P = Q * R Poiseuille’s Equation : Vessel Capacitance: Fluid Inertia:

  10. The Wheatstone Bridge:

  11. The Wheatstone Bridge

  12. Balancing the Bridge Anterograde: No Flow: Retrograde:

  13. DRILing the Bridge Anterograde: No Flow: Retrograde:

  14. Objective#1: Circuit Model

  15. Objective #1: Pulsatile

  16. Objective#2: Distal Flow

  17. Objective#3: DRIL Effect Collateral Anterograde: No Flow: Retrograde:

  18. Conclusion: • Retrograde flow is promoted by Distal Revascularization: decreasing collateral resistance • Anterograde flow is promoted by Distal Revascularization: decreasing resistance of proximal segment • Interval Ligation removes the distal conduit and effectively removes retrograde flow • Collateral ligation supports anterograde flow

  19. Objectives: • Model physiologic pulsatile blood flow in a Brachial-Cephalic AVF • Observe retrograde blood flow in the arterial segment distal to AVF as a surrogate of access related distal ischemia (ARI) • Observe effect of capacitance and resistance produced by the Distal Revascularization-Interval Ligation procedure

More Related