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These grafts are conduits between higher pressure arteries and lower pressure veins. The connection on the vein end of the graft, known as the\u00a0graft-to-vein anastomosis, fails frequently and chronically due to\u00a0high rates of stenosis and thrombosis. These failures are widely believed to be associated with\u00a0pathologically high and low flow shear strain rates at the graft-to-vein anastomosis. We hypothesized that consistent with pipe flow dynamics and prior work exploring vein-to-artery anastomosis angles in arteriovenous fistulas, altering the graft-to-vein anastomosis angle can reduce the incidence of pathological shear rate fields. We tested this via computational fluid dynamic simulations of idealized arteriovenous grafts,\u00a0using the Bird-Carreau constitutive law for blood. We observed that low graft-to-vein anastomosis angles (\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$&lt;20^{\\circ }$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mrow>\n                            <mml:mo>&lt;<\/mml:mo>\n                            <mml:msup>\n                              <mml:mn>20<\/mml:mn>\n                              <mml:mo>\u2218<\/mml:mo>\n                            <\/mml:msup>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ) led to increased incidence of pathologically low shear rates,\u00a0and\u00a0that high graft-to-vein anastomosis angles (\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$&gt;40^{\\circ }$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mrow>\n                            <mml:mo>&gt;<\/mml:mo>\n                            <mml:msup>\n                              <mml:mn>40<\/mml:mn>\n                              <mml:mo>\u2218<\/mml:mo>\n                            <\/mml:msup>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ) led to increased incidence of\u00a0pathologically high shear rates. Optimizations predicted that an intermediate\u00a0 (\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$\\sim 30^\\circ$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mrow>\n                            <mml:mo>\u223c<\/mml:mo>\n                            <mml:msup>\n                              <mml:mn>30<\/mml:mn>\n                              <mml:mo>\u2218<\/mml:mo>\n                            <\/mml:msup>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ) graft-to-anastomosis angle was optimal. Our study demonstrates that graft-to-vein anastomosis angles can significantly impact pathological flow fields, and can be optimized to substantially improve arteriovenous graft patency rates.\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-90813-3","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T06:16:45Z","timestamp":1623219405000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Tailoring of arteriovenous graft-to-vein anastomosis angle to attenuate pathological flow fields"],"prefix":"10.1038","volume":"11","author":[{"given":"Dillon","family":"Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric C.","family":"Leuthardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy M.","family":"Genin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Zayed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,6,9]]},"reference":[{"key":"90813_CR1","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.medengphy.2009.10.013","volume":"32","author":"Z Kharboutly","year":"2010","unstructured":"Kharboutly, Z., Deplano, V., Bertrand, E. & Legallais, C. 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Physician"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90813-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90813-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90813-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T08:12:39Z","timestamp":1675411959000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-90813-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,9]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["90813"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-90813-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,9]]},"assertion":[{"value":"2 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"DW has no competing interests. ECL, GMG, and MAZ have equity in the company Caeli Vascular, Inc. This company specializes in venous thrombectomy devices and does not manufacture or produce arteriovenous grafts.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12153"}}