Computational model for estimating the short- and long-term cardiac response to arteriovenous fistula creation for hemodialysis.

Creation of an arteriovenous fistula (AVF) for hemodialysis may result in cardiac failure due to dramatic increases in cardiac output. To investigate the quantitative relations between AVF flow, changes in cardiac output, myocardial stress and strain and resulting left ventricular adaptation, a computational model is developed. The model combines a one-dimensional pulse wave propagation model of the arterial network with a zero-dimensional one-fiber model of cardiac mechanics and includes adaptation rules to capture the effect of the baro-reflex and long-term structural remodelling of the left ventricle. Using generic vascular and cardiac parameters based on literature, simulations are done that illustrate the model's ability to quantitatively reproduce the clinically observed increase in brachial flow and cardiac output as well as occurence of eccentric hypertrophy. Patient-specific clinical data is needed to investigate the value of the computational model for personalized predictions.

A numerical method of reduced complexity for simulating vascular hemodynamics using coupled 0D lumped and 1D wave propagation models.

A computational method of reduced complexity is developed for simulating vascular hemodynamics by combination of one-dimensional (1D) wave propagation models for the blood vessels with zero-dimensional (0D) lumped models for the microcirculation. Despite the reduced dimension, current algorithms used to solve the model equations and simulate pressure and flow are rather complex, thereby limiting acceptance in the medical field. This complexity mainly arises from the methods used to combine the 1D and the 0D model equations. In this paper a numerical method is presented that no longer requires additional coupling methods and enables random combinations of 1D and 0D models using pressure as only state variable. The method is applied to a vascular tree consisting of 60 major arteries in the body and the head. Simulated results are realistic. The numerical method is stable and shows good convergence.

Clinical study protocol for the ARCH project - computational modeling for improvement of outcome after vascular access creation.

Despite clinical guidelines and the possibility of diagnostic vascular imaging, creation and maintenance of a vascular access (VA) remains problematic: avoiding short- and long-term VA dysfunction is challenging. Although prognostic factors for VA dysfunction have been identified in previous studies, their potential interplay at a systemic level is disregarded. Consideration of multiple prognostic patient specific factors and their complex interaction using dedicated computational modeling tools might improve outcome after VA creation by enabling a better selection of VA configuration. These computational modeling tools are developed and validated in the ARCH project: a joint initiative of four medical centers and three industrial partners (FP7-ICT-224390). This paper reports the rationale behind computational modeling and presents the clinical study protocol designed for calibrating and validating these modeling tools. The clinical study is based on the pre-operative collection of structural and functional data at a vascular level, as well as a VA functional evaluation during the follow-up period. The strategy adopted to perform the study and for data collection is also described here.