An arteriovenous fistula (AVF) is a permanent vascular access created surgically connecting a vein onto an artery. It enables to circulate blood extra-corporeally in order to clean it from metabolic waste products and excess of water for patients with end-stage renal disease undergoing hemodialysis. The hemodynamics results to be significantly altered within the arteriovenous fistula compared to the physiological situation. Several studies have been carried out in order to better understand the consequences of AVF creation, maturation and frequent use, but many clinical questions still lie unanswered. The aim of the present study is to better understand the hemodynamics within the AVF, when the compliance of the vascularwall is taken into account. We also propose to quantify the effect of a stenosis at the afferent artery, the incidence of which has been underestimated for many years. The fluid-structure interactions (FSI) within a patient-specific radio-cephalic arteriovenous fistula are investigated numerically. The considered AVF presents an 80% stenosis at the afferent artery. The patient-specific velocity profile is imposed at the boundary inlet, and a Windkessel model is set at the arterial and venous outlets. The mechanical properties of the vein and the artery are differentiated. The non-Newtonian blood behavior has been taken into account. The FSI simulation advantageously provides the time-evolution of both the hemodynamic and structural stresses, and guarantees the equilibrium of the solution at the interface between the fluid and solid domains. The FSI results show the presence of large zones of blood flow recirculation within the cephalic vein, which might promote neointima formation. Large internal stresses are also observed at the venous wall, which may lead to wall remodeling. The fully-coupled FSI simulation results to be costly in computational time, which can so far limit its clinical use. We have investigated whether uncoupled fluid and structure simulations can provide accurate results and significantly reduce the computational time. The uncoupled simulations have the advantage to run 5 times faster than the fully-coupled FSI. We show that an uncoupled fluid simulation provides informative qualitative maps of the hemodynamic conditions in the AVF. Quantitatively, the maximum error on the hemodynamic parameters is 20%. The uncoupled structural simulation with non-uniform wall properties along the vasculature provides the accurate distribution of internal wall stresses, but only at one instant of time within the cardiac cycle. Although partially inaccurate or incomplete, the results of the uncoupled simulations could still be informative enough to guide clinicians in their decision-making. In the second part of the study we have investigated the effects of the arterial stenosis on the hemodynamics, and simulated its treatment by balloon-angioplasty. Clinically, balloon-angioplasty rarely corrects the stenosis fully and a degree of stenosis remains after treatment. Residual degrees of stenosis below 30% are considered as successful. We have inflated the balloon with different pressures to simulate residual stenoses ranging from 0 to 30%. The arterial stenosis has little impact on the blood flow distribution: the venous flow rate remains unchanged before and after the treatment and thus permits hemodialysis. But an increase in the pressure difference across the stenosis is observed, which could cause the heart work load to increase. To guarantee a pressure drop below 5 mmHg, which is considered as the threshold stenosis pressure difference clinically, we find that the residual stenosis degree must be 20% maximum.
