Affiliations: Laboratory of Biomechanics, Center for Experimental Surgery, Foundation of Biomedical Research, Academy of Athens, Athens, Greece | Laboratory of Biofluid Mechanics and Biomedical Engineering, School of Mechanical Engineering, National Technical University, Athens, Greece | Vascular Unit, 3rd Department of Surgery, University Hospital ‘Atticon’, Athens University Medical School, Athens, Greece | Laboratory of Hemodynamics and Cardiovascular Technology, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
Note: [] Address for correspondence: Dr. Dimitrios P. Sokolis, Lefkados St. 35, Athens 15354, Greece. Tel.: +30 210 659 7370; Fax: +30 210 659 7365; E-mail: [email protected].
Abstract: While the role of hemodynamic variables on the development of intimal hyperplasia in arteriovenous fistulas for hemodialysis has been examined, less is known about the intramural biomechanical factors. In this study, arteriovenous fistulas were created by implantation of e-PTFE grafts between carotid artery and jugular vein in healthy pigs. In vivo recordings exhibited a three-fold pressure and flow elevation in grafted veins after fistula creation, remaining so until sacrifice. The chief morphological observation in grafted vessels was wall thickening at two weeks, serving to restore intramural stresses to homeostatic levels, and a less marked internal diameter enlargement, gradually normalizing intimal shear after four weeks. The residual strains and opening angle, specifying the zero-stress configuration, increased with differences reaching significance at twelve weeks. Association with histomorphological findings on intima, media and adventitia growth disclosed a correlation between intimal hyperplasia and opening angle increase. Elastin and cellular contents diminished opposite to collagen content, most differences occurring within the first four weeks after grafting. Inflation/extension testing showed that post-fistula the vein wall became progressively thicker and stiffer, lacking restoration of compliance to baseline levels. The present data may further our understanding of the dynamics of venous biomechanical remodeling under pressure and flow-overload conditions.
