Comparison of two Endovascular Treatments of a Stenosed Arteriovenous Fistula: Balloon-Angioplasty with and without Stenting

Abstract

Purpose Arteriovenous fistulas (AVFs) are created in patients to enable a permanent vascular access for hemodialysis. The AVF causes changes in the hemodynamic conditions leading to possible complications, stenoses being the most common one. Our objective was to compare the effect of treating the stenosed AVF by balloon-angioplasty, whether followed or not with stenting. Methods We considered an AVF presenting an 60% arterial stenosis and simulated the two endovascular treatments using an implicit approach. We then simulated the fluid-structure interactions (FSI) within (i) the patient-specific stenosed AVF, (ii) the AVF after angioplasty, and (iii) the AVF after angioplasty plus stenting with ANSYS Workbench. Results We show that a self-expandable stent does not modify the curvature of the vessel after angioplasty; it only increases the local Young modulus of the stented wall by an order of magnitude. The results of the FSI simulations indicate that the two treatments induce the same hemodynamic conditions: they both reduce the pressure difference across the stenosis, while maintaining the flow distribution downstream of the stenosis. The venous flow rate that has to be guaranteed for hemodialysis is unaltered. Thanks to its large axial flexibility, the self-expandable stent causes at maximum a three-fold increase in the internal wall stresses at peak systole as compared to angioplasty alone. Conclusions By maintaining the vessel lumen shape over time, the stent is likely to reduce the risk of restenosis that can otherwise occur after balloon-angioplasty because of the viscoelastic recoil of the vessel.