{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:13:57Z","timestamp":1777464837242,"version":"3.51.4"},"reference-count":35,"publisher":"SAGE Publications","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BME"],"published-print":{"date-parts":[[2022,9,9]]},"abstract":"<jats:p>BACKGROUND: Arteriovenous fistula (AVF) is the preferred route of vascular access in hemodialysis. The primary reason of fistula failure is intimal hyperplasia (IH), which leads to stenosis. Wall shear stress (WSS) and disturbed flow are the critical parameters in the formation of IH. OBJECTIVE: The primary goal of this study is to explore the influence of anastomosis angle on WSS and venous outflow rate, as well as to find the ideal angle of anastomosis for AVF to standardize surgical technique. METHODS: Three-dimensional idealized geometries of end-to-side type AVF for the five various angles of anastomosis are considered in this study. The WSS, blood flow rate at the venous outlet for non-Newtonian, pulsatile blood flow are calculated using a numerical simulation technique. RESULTS: The WSS is higher at 75\u00b0 compared to other angles and least at 45\u00b0 for pulsating arterial inflows. The WSS is moderate at 30\u00b0, 60\u00b0 and 90\u00b0. On the arterial bed and outer wall of the vein, immediately after the anastomosis, the recirculation zone is observed. At an angle of 45\u00b0 and 90\u00b0 anastomosis, the outflow rate is greater at distal venous end. CONCLUSIONS: If one believes that high wall shear stress causes IH within the AVF, the results suggest that the AVF should be formed at a 45\u00b0 angle to avoid IH. However, if one believes that low wall shear stress causes IH within the AVF, the results suggest that AVF should be formed at either 30\u00b0 or 75\u00b0 to avoid IH. The findings spotlight the importance of anastomosis angle in determining AVF hemodynamics.<\/jats:p>","DOI":"10.3233\/bme-211389","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T13:47:10Z","timestamp":1646401630000},"page":"423-436","source":"Crossref","is-referenced-by-count":5,"title":["Prediction of the anastomosis angle of arteriovenous fistula in hemodialysis to standardize the surgical technique"],"prefix":"10.1177","volume":"33","author":[{"given":"Suraj N.","family":"Shembekar","sequence":"first","affiliation":[{"name":", Visvesvaraya National Institute of Technology, , , India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.B.","family":"Zodpe","sequence":"additional","affiliation":[{"name":", Visvesvaraya National Institute of Technology, , , India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.M.","family":"Padole","sequence":"additional","affiliation":[{"name":", Visvesvaraya National Institute of Technology, , , India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"key":"10.3233\/BME-211389_ref1","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/S0021-9290(98)00059-1","article-title":"Flow waveform effects on end-to-side anastomotic flow patterns","volume":"31","author":"Ethier","year":"1998","journal-title":"J Biomech"},{"issue":"9","key":"10.3233\/BME-211389_ref2","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/S0021-9290(99)00088-3","article-title":"Flow patterns in the radiocephalic arteriovenous fistula: An in vitro study","volume":"32","author":"Sivanesan","year":"1999","journal-title":"J Biomech"},{"issue":"1","key":"10.3233\/BME-211389_ref3","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jvs.2012.10.070","article-title":"Computational fluid dynamic evaluation of the side-to-side anastomosis for arteriovenous fistula","volume":"58","author":"Hull","year":"2013","journal-title":"J Vasc Surg"},{"issue":"3","key":"10.3233\/BME-211389_ref4","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s13239-017-0321-2","article-title":"The effect of arterial curvature on blood flow in arterio-venous fistulae: Realistic geometries and pulsatile flow","volume":"8","author":"Grechy","year":"2017","journal-title":"Cardiovasc Eng Technol"},{"issue":"L","key":"10.3233\/BME-211389_ref5","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/112972981001100111","article-title":"Hemodynamic impact of anastomosis size and angle in side-to-end arteriovenous fistulae: A computer analysis","volume":"2005","author":"Van Canneyt","year":"2010","journal-title":"J Vasc Access"},{"issue":"1","key":"10.3233\/BME-211389_ref6","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/ndt\/gfr342","article-title":"Disturbed flow in radial-cephalic arteriovenous fistulae for haemodialysis: Low and oscillating shear stress locates the sites of stenosis","volume":"27","author":"Ene-Iordache","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"10.3233\/BME-211389_ref7","first-page":"112","article-title":"A numerical simulation of flow in a two-dimensional end-to-side anastomosis model","author":"Ethier","year":"2016","journal-title":"J Biomech Eng"},{"issue":"1","key":"10.3233\/BME-211389_ref8","first-page":"69","article-title":"Simulations of the blood flow in the arterio-venous fistula for haemodialysis","volume":"16","author":"Jodko","year":"2014","journal-title":"Acta Bioeng Biomech"},{"key":"10.3233\/BME-211389_ref9","first-page":"1","article-title":"Characterization of the flow-field in a patient-specific model of arteriovenous fistula for hemodialysis","author":"Bozzetto","year":"2016","journal-title":"International CAE Conference 2016 Parma Italy"},{"key":"10.3233\/BME-211389_ref10","volume-title":"Proc 21st Australas Fluid Mech Conf AFMC 2018","author":"Barber","year":"2018"},{"issue":"2","key":"10.3233\/BME-211389_ref11","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.medengphy.2009.10.013","article-title":"Medical Engineering & Physics Numerical and experimental study of blood flow through a patient-specific arteriovenous fistula used for hemodialysis","volume":"32","author":"Kharboutly","year":"2010","journal-title":"Med Eng Phys [Internet]"},{"issue":"4","key":"10.3233\/BME-211389_ref12","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1007\/s10439-012-0703-4","article-title":"Vascular remodeling in autogenous arterio-venous fistulas by MRI and CFD","volume":"41","author":"Igovan","year":"2013","journal-title":"Ann Biomed Eng"},{"key":"10.3233\/BME-211389_ref13","first-page":"1","article-title":"Incomplete restoration of homeostatic shear stress within arteriovenous fistulae","volume":"135","author":"Patrick","year":"2013","journal-title":"J Biomech Eng"},{"key":"10.3233\/BME-211389_ref14","first-page":"11","volume-title":"Proc 19th Australas Fluid Mech Conf AFMC 2014","author":"Lwin","year":"2014"},{"issue":"5","key":"10.3233\/BME-211389_ref15","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1002\/fld.2381","article-title":"Numerical simulation of the haemodynamics in end-to-side anastomoses","volume":"67","author":"Do","year":"2011","journal-title":"Int J Numer Methods Fluids [Internet]"},{"issue":"3","key":"10.3233\/BME-211389_ref16","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1115\/1.2895739","article-title":"The effect of angle and flow rate upon hemodynamics in distal vascular graft anastomoses: A numerical model study","volume":"116","author":"Fei","year":"1994","journal-title":"J Biomech Eng"},{"key":"10.3233\/BME-211389_ref17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fbioe.2020.00846","article-title":"The anastomotic angle of hemodialysis arteriovenous fistula is associated with flow disturbance at the venous stenosis location on angiography","volume":"8","author":"Yang","year":"2020","journal-title":"Front Bioeng Biotechnol"},{"issue":"1","key":"10.3233\/BME-211389_ref18","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1093\/ndt\/14.1.118","article-title":"Sites of stenosis in AV fistulae for haemodialysis access","volume":"14","author":"Sivanesan","year":"1999","journal-title":"Nephrol Dial Transplant"},{"issue":"1","key":"10.3233\/BME-211389_ref19","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/j.1525-139X.2012.01062.x","article-title":"Arteriovenous fistula creation using the optiflow vascular anastomosis device: A first in man pilot study","volume":"26","author":"Manson","year":"2013","journal-title":"Semin Dial"},{"issue":"4","key":"10.3233\/BME-211389_ref20","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1016\/j.jvs.2014.11.082","article-title":"Prospective controlled pilot study of arteriovenous fistula placement using the novel Optiflow device","volume":"61","author":"Nikam","year":"2015","journal-title":"J Vasc Surg [Internet]"},{"key":"10.3233\/BME-211389_ref21","doi-asserted-by":"publisher","first-page":"031903","DOI":"10.1063\/1.4913754","article-title":"The effect of in-plane arterial curvature on blood flow and oxygen transport in arterio-venous fistulae","author":"Gedroyc","year":"2015","journal-title":"Phys Fluids"},{"issue":"1","key":"10.3233\/BME-211389_ref22","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.jbiomech.2012.09.005","article-title":"Serial analysis of lumen geometry and hemodynamics in human arteriovenous fistula for hemodialysis using magnetic resonance imaging and computational fluid dynamics","volume":"46","author":"He","year":"2013","journal-title":"J Biomech [Internet]"},{"issue":"6","key":"10.3233\/BME-211389_ref23","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1161\/01.CIR.87.6.1915","article-title":"Blood viscosity, fibrinogen, and activation of coagulation and leukocytes in peripheral arterial disease and the normal population in the Edinburgh artery study","volume":"87","author":"Lowe","year":"1993","journal-title":"Circulation"},{"issue":"3","key":"10.3233\/BME-211389_ref24","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3233\/BIR-1991-283-415","article-title":"Effects of the non-newtonian viscosity of blood on flows in a diseased arterial vessel. Part 1: Steady flows","volume":"28","author":"Cho","year":"1991","journal-title":"Biorheology"},{"issue":"8","key":"10.3233\/BME-211389_ref25","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1080\/10255842.2010.493514","article-title":"Pulsatile non-Newtonian haemodynamics in a 3D bifurcating abdominal aortic aneurysm model","volume":"14","author":"Ma","year":"2011","journal-title":"Comput Methods Biomech Biomed Engin"},{"key":"10.3233\/BME-211389_ref26","doi-asserted-by":"crossref","first-page":"36","DOI":"10.5301\/JVA.2011.8440","article-title":"Computational Fluid Dynamics simulation of A-V fistulas: From MRI and ultrasound scans to numeric evaluation of hemodynamics","volume":"13","author":"Niemann","year":"2012","journal-title":"J Vasc Access"},{"issue":"3","key":"10.3233\/BME-211389_ref27","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.bbe.2017.05.006","article-title":"Blood flows in end-to-end arteriovenous fistulas: Unsteady and steady state numerical investigations of three patient-specific cases","volume":"37","author":"Jodko","year":"2017","journal-title":"Biocybern Biomed Eng"},{"issue":"5","key":"10.3233\/BME-211389_ref28","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/0021-9290(82)90057-4","article-title":"Steady flow in a model of the human carotid bifurcation. Part I-Flow visualization","volume":"15","author":"Bharadvaj","year":"1982","journal-title":"J Biomech"},{"key":"10.3233\/BME-211389_ref29","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/cnm.2595","article-title":"Numerical simulation of the fluid structure interactions in a compliant patient-specif IC arteriovenous fistula","volume":"30","author":"Decorato","year":"2014","journal-title":"Int. J. Numer. Meth. Biomed. Engng."},{"issue":"7","key":"10.3233\/BME-211389_ref30","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s10439-012-0695-0","article-title":"High wall shear stress and spatial gradients in vascular pathology: A review","volume":"41","author":"Stroke","year":"2013","journal-title":"Ann Biomed Eng"},{"issue":"1","key":"10.3233\/BME-211389_ref31","first-page":"25","article-title":"The mechanical test method of cardiov ascular and related biomaterials","volume":"1","author":"Yokobori","year":"1991","journal-title":"Biomed Mater Eng"},{"issue":"4","key":"10.3233\/BME-211389_ref32","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1097\/01.mat.0000169126.91756.1d","article-title":"Experimental analysis of the hemodynamics in punctured vascular access grafts","volume":"51","author":"Van Tricht","year":"2005","journal-title":"ASAIO J"},{"key":"10.3233\/BME-211389_ref33","doi-asserted-by":"crossref","first-page":"IV-3X","DOI":"10.1161\/01.CIR.40.5S4.IV-38","article-title":"Certain chemorheologic considerations regarding the blood vascular interface with particular reference to coronary artery disease","volume":"40","author":"Fry","year":"1969","journal-title":"Circulation"},{"key":"10.3233\/BME-211389_ref34","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.1971.0019"},{"issue":"9","key":"10.3233\/BME-211389_ref35","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1007\/s10439-005-5367-X","article-title":"Hemodynamics and complications encountered with arteriovenous fistulas and grafts as vascular access for hemodialysis: A review","volume":"33","author":"Van Tricht","year":"2005","journal-title":"Ann Biomed Eng"}],"container-title":["Bio-Medical Materials and Engineering"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/BME-211389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T13:24:16Z","timestamp":1777382656000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/BME-211389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,9]]},"references-count":35,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3233\/bme-211389","relation":{},"ISSN":["0959-2989","1878-3619"],"issn-type":[{"value":"0959-2989","type":"print"},{"value":"1878-3619","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,9]]}}}