Optimal Biomaterial Selection For Anastomosis Device For AV Fistula Surgery Using Multi-Criteria Decision Making Method
Keywords:
AV fistula, biomaterials, MCDM, analytic hierarchy process, silicone, hemodialysisAbstract
Arteriovenous fistula (AVF) failure remains a critical challenge in hemodialysis access, with 30–60% of cases failing due to anastomotic complications. This study employs Multi-Criteria Decision Making (MCDM) through the Analytic Hierarchy Process (AHP) to evaluate and compare implant-grade silicone with Nitinol and ePTFE based on existing literature. Five weighted criteria—biocompatibility (30%), mechanical performance (25%), endothelialization (20%), manufacturing feasibility (15%), and thrombogenicity (10%)—were used for systematic assessment. Literature-derived scores yielded a total AHP score of 8.1 for silicone, surpassing Nitinol (6.2) and ePTFE (4.5). Published in vitro and in vivo findings were analyzed to confirm silicone’s superior hemocompatibility and patency rates. These results demonstrate that silicone is a highly promising candidate for anastomotic device development in AVF surgery and present a reproducible framework for evidence-based biomaterial selection.
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References
United States Renal Data System, "2022 Annual Data Report: Epidemiology of Kidney Disease in the United States," National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2022.
A. N. Sidawy et al., "The Society for Vascular Surgery: Clinical Practice Guidelines for the Surgical Placement and Maintenance of Arteriovenous Hemodialysis Access," J. Vasc. Surg., vol. 48, no. 5, pp. S2–S25, 2008.
K. M. Lok and J. M. Foley, "Vascular access morbidity and mortality: trends of the last decade," Clin. J. Am. Soc. Nephrol., vol. 8, no. 7, pp. 1213–1219, 2013.
D. Roy-Chaudhury et al., "Hemodialysis vascular access dysfunction: from pathophysiology to novel therapies," Blood Purif., vol. 23, no. 1, pp. 57–65, 2005.
B. Ene-Iordache et al., "Computational fluid dynamics of a vascular access case for hemodialysis," Nephrol. Dial. Transplant., vol. 31, no. 3, pp. 365–375, 2016.
V. S. Sottiurai et al., "Distal anastomotic intimal hyperplasia: a cause of graft failure," J. Vasc. Surg., vol. 23, no. 3, pp. 408–418, 1996.
D. Stoeckel, A. Pelton, and T. Duerig, "Self-expanding nitinol stents: material and design considerations," Eur. Radiol., vol. 14, no. 2, pp. 292–301, 2004.
B. Dolmatch et al., "Endovascular intervention in the thrombosed hemodialysis graft," J. Vasc. Interv. Radiol., vol. 23, no. 5, pp. 613–621, 2012.
International Organization for Standardization, "ISO 10993-4: Biological evaluation of medical devices—Part 4: Selection of tests for interactions with blood," ISO, Geneva, Switzerland, 2017.
ASTM International, "ASTM F2477: Standard Test Method for in vitro Pulsatile Durability Testing of Vascular Stents," ASTM, West Conshohocken, PA, 2021.
T. L. Saaty, Decision Making for Leaders: The Analytic Hierarchy Process for Decisions in a Complex World, Pittsburgh, PA: RWS Publications, 2008.
R. W. Saaty, "How to make a decision: The analytic hierarchy process," Eur. J. Oper. Res., vol. 48, no. 1, pp. 9–26, 1990.
J. M. Anderson, "Biological responses to materials," Annu. Rev. Mater. Res., vol. 31, pp. 81–110, 2001.
J. L. MacDonald et al., "Development of an animal model of arteriovenous fistula failure," J. Surg. Res., vol. 180, no. 1, pp. 117–124, 2013.
FDA, "Premarket Approval (PMA)," U.S. Food and Drug Administration, 2021. [Online]. Available: https://www.fda.gov/medical-devices
A. L. Bosworth and R. J. Downes, "The mechanical properties of elastomers for biomedical applications," J. Mater. Sci. Mater. Med., vol. 24, pp. 1273–1281, 2013.
S. A. Gaharwar et al., "Advanced strategies for vascular tissue engineering: a materials science perspective," Adv. Mater., vol. 30, no. 29, p. 1705915, 2018.
Y. Xia and G. M. Whitesides, "Soft lithography," Annu. Rev. Mater. Sci., vol. 28, no. 1, pp. 153–184, 1998.
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