A Computational Technique for Robust Optimization of Cardiovascular Bypass Graft Surgeries

2010 ◽  
Author(s):  
Sethuraman Sankaran ◽  
Alison L. Marsden
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Computational Technique ◽  
First Year ◽  
Synthetic Material ◽  
Plaque Deposition ◽  
Wall Shear

Bypass graft (BG) surgeries involve surgical construction of a graft over a blocked blood vessel. The graft can either be native tissue of the patient or a synthetic material. Some commonly performed BG surgeries include aorto-bifemoral, femoro-popliteal, femoro-tibial, and coronary artery bypass (CABG). The operative mortality rate for CABG is around 3%. Around 15 to 30% of bypass grafts occlude within the first year of surgery, increasing to over 50% after 10 years. Graft incompatibility, and hemodynamic factors such as blood recirculation, low wall shear stress, and abnormal wall shear stress gradients play an important role in the onset and development of intimal thickening and plaque deposition (atherogenesis).

Preliminary Near Wall Hemodynamic Evaluation of a Coronary Artery Bypass Graft Model With a Flow Streamlining Implant

2002 ◽  
Author(s):  
Pedro D. Pedroso ◽  
Andreas S. Anayiotos ◽  
Brad L. Hershey ◽  
Evangelos Eleftheriou ◽  
William L. Holman
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Saphenous Vein ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Wall Shear

Coronary artery disease (CAD) is the leading cause of death in the world today. According to the American Heart Association 529,659 people in 1999 died as a result of CAD [1]. Starting in the 1960’s, surgeons have used Coronary Artery Bypass Graft (CABG) techniques in order to reestablish blood flow to the heart. Today, the procedure remains the same, using autologous grafts, such as the mammary artery and the saphenous vein. An unresolved problem, is that a significant number of CABGs reocclude months to years postoperatively. In the case of Saphenous Vein Grafts (SVGs) typically 50% of these bypasses are totally occluded months to years after the procedure, the remaining half being more than 50% occluded [2]. The re-occlusion of CABGs is due to a process labeled intimal hyperplasia (IH). Investigators have shown that IH, believed by some to be a remodeling process, occurs at branch sites, regions of curvature, and anastomotic junctions [3,4]. At these sites there are low residence times, slow secondary structures, disturbed flow, and areas of recirculation, therefore the onset of IH is believed to be hemodynamically linked. Most recently, floor IH has been attributed to four variables: time averaged wall shear stress (WSS), oscillating shear index (OSI), spatial wall shear stress gradients (WSSG), and temporal WSSG [5]. Adverse values of these parameters, in the case of SVGs, are believed to be caused by impedance mismatch at the anastomosis site. Over time this characteristic causes a bulge at the sinus. Such a morphology additionally contributes to disturbed flows which tend to propagate down the CABG and are believed to play a major role in the development of IH and the eventual failure of the graft.

Characterizing Flow in the Vertebro-Basilar System Using MR in Conjunction With Subject-Specific Computational Models

2010 ◽  
Author(s):  
Amanda K. Wake ◽  
John C. Gore ◽  
J. Christopher Gatenby
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Vascular Graft ◽  
Graft Failure ◽  
Computational Models ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Arterial Graft ◽  
Vessel Patency ◽  
Wall Shear

Coronary artery bypass graft failure is often a consequence of intimal hyperplasia (IH), which correlates with hemodynamic factors (e.g., wall shear stress); this relationship has been used to evaluate arterial graft design [e.g., 1–4]. The vertebro-basilar system is a native arterial merge (i.e., two arteries, the vertebrals, converge into a single artery, the basilar artery); thus, characterizing the flow field of this system in healthy subjects could be useful for early detection of anomalies (e.g., aneurysms) or for vascular graft design improvements to ensure graft/vessel patency. This study uses high field MR and phase contrast MR (PCMR) to investigate the hemodynamics of the vertebro-basilar system in a healthy, adult subject for predicting pathophysiologically-relevant flow patterns (e.g., low wall shear stress) that are related to IH and subsequent graft failure.

scholarly journals Impact of Competitive Flow on Hemodynamics in Coronary Surgery: Numerical Study of ITA-LAD Model

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Jinli Ding ◽  
Youjun Liu ◽  
Feng Wang ◽  
Fan Bai
Keyword(s):  
Shear Stress ◽  
Coronary Artery ◽  
Wall Shear Stress ◽  
Numerical Study ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Coronary Bypass ◽  
Coronary Artery Bypass Grafts ◽  
Wall Shear ◽  
The Impact

Competitive flow from native coronary artery is considered as a major factor in the failure of the coronary artery bypass grafts. However, the physiological effects are not very clear. The aim is to research the impact of competitive flow caused by different left anterior descending (LAD) artery stenosis degrees on hemodynamics in internal thoracic artery (ITA) bypass graft. An idealized ITA-LAD model was built in CAD tools. The degree of the competitive flow was divided into five classes according to different LAD stenosis degrees: higher (no stenosis), secondary (30% stenosis), reduced (50% stenosis), lower (75% stenosis) and no competitive flow (fully stenosis). Finite volume method was employed for the numerical simulation. The flow velocity distributions, wall shear stress and oscillatory shear index were analyzed. Results showed that higher competitive flow in the bypass graft would produce unbeneficial wall shear stress distribution associating with endothelial dysfunction and subsequent graft failure. The coronary bypass graft surgery was preferred to be carried out when the LAD stenosis was higher than 75%.

Pressure Induced Strain at Femoral Artery Bypass Graft Junctions

2007 ◽  
Author(s):  
Triona Campbell ◽  
Reena Cole ◽  
Michael O’Donnell
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Arterial Disease ◽  
Shear Stresses ◽  
Artery Bypass Graft ◽  
Short Period ◽  
Wall Shear ◽  
Hydrodynamic Stresses

Femoral or femoropopliteal artery bypass graft junctions have a predilection for failure due to restenosis. It has been clinically proven that vascular reconstructions tend to restenose within a short period of time [1]. Extensive studies have cited wall shear stresses as being primarily responsible and definite correlations between hydrodynamic stresses in the arterial wall and arterial disease have been shown [2,3]. However intensive investigations into wall shear stresses have lead to conflicting arguments on the proliferation and propagation of stenoses. It was concluded by Freidman [4] that the intima at sites exposed to relatively high or unidirectional shears thickened initially, but as time progressed the greatest thicknesses were ultimately achieved at sites exposed to lower or more oscillatory shear environments. A contradicting view was expressed by Nazemi [5] that low wall shear stress contributed to the onset of atherosclerotic plaque formation, whilst high wall shear stress encouraging plaque growth. A number of studies have however established a statistically significant correlation between pressure and intimal hyperplasia and concluded that blood pressure and not blood flow is the primary factor responsible for the localization of atherosclerosis [6–8].

The Effect of Wall Distensibility on Flow in a Two-Dimensional End-to-Side Anastomosis

1994 ◽  
Vol 116 (3) ◽  
pp. 294-301 ◽  
Author(s):  
D. A. Steinman ◽  
C. Ross Ethier
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Intimal Hyperplasia ◽  
Bypass Graft ◽  
Numerical Approach ◽  
Flow Patterns ◽  
Temporal Variations ◽  
Model Studies ◽  
Wall Shear ◽  
Wall Distensibility

The development of intimal hyperplasia at the distal anastomosis is the major cause of long-term bypass graft failure. To evaluate the suspected role of hemodynamic factors in the pathogenesis of distal intimal hyperplasia, an understanding of anastomotic flow patterns is essential. Due to the complexity of arterial flow, model studies typically make simplifying assumptions, such as treating the artery and graft walls as rigid. In the present study this restriction is relaxed to consider the effects of vessel wall distensibility on anastomotic flow patterns. Flow was simulated in an idealized 2-D distensible end-to-side anastomosis model, using parameters appropriate for the distal circulation and assuming a purely elastic artery wall. A novel numerical approach was developed in which the wall velocities are solved simultaneously with the fluid and pressure fields, while the wall displacements are treated via an iterative update. Both the rigid and distensible cases indicated the presence of elevated temporal variations and low average magnitudes of wall shear stress at sites known to be susceptible to the development of intimal hyperplasia. At these same sites, large spatial gradients of wall shear stress were also noted. Comparison between distensible-walled and corresponding rigid-walled simulations showed moderate changes in wall shear stress at isolated locations, primarily the bed, toe and heel. For example, in the case of a distensible geometry and a physiologic pressure waveform, the heel experienced a 38 percent increase in cycle-averaged shear stress, with a corresponding 15 percent reduction in shear stress variability, both relative to the corresponding values in the rigid-walled case. However, other than at these isolated locations, only minor changes in overall wall shear stress patterns were observed. While the physiological implications of such changes in wall shear stress are not known, it is suspected that the effects of wall distensibility are less pronounced than those brought about by changes in arterial geometry and flow conditions.

Design and Analysis of a Shear Stress Sensor for Microcirculation Investigations (Invited Paper)

2003 ◽  
Author(s):  
Risa Robinson ◽  
Lynn Fuller ◽  
Harvey Palmer ◽  
Mary Frame
Keyword(s):  
Blood Flow ◽  
Shear Stress ◽  
Wall Shear Stress ◽  
Computational Technique ◽  
Flow Modification ◽  
Stress Sensors ◽  
Shear Stress Sensors ◽  
Wall Shear

Blood flow regulation in the microvascular network has been investigated by means of computational fluid dynamics, in vivo particle tracking and microchannel models. It is evident from these studies that shear stress along the wall is a key factor in the communication network that results in blood flow modification, yet current methods for shear stress determination are acknowledged to be imprecise. Micromachining technology allows for the development of implantable shear stress sensors that will enable us to monitor wall shear stress at multiple locations in arteriole bifurcations. In this study, a microchannel was employed as an in vitro model of a microvessel. Thermal shear stress sensors were used to mimic the endothelial cells that line the vessel wall. A three dimensional computational model was created to simulate the system’s thermal response to the constant temperature control circuit and related wall shear stress. The model geometry included a silicon wafer section with all the fabrication layers — silicon dioxide, poly silicon resistor, silicon nitride — and a microchannel with cross section 17 μm × 17 μm. This computational technique was used to optimize the dimensions of the system for a 0.01 Reynolds number flow at room temperature in order to reduce the amount of heat lost to the substrate and to predict and maximize the signal response. Results of the design optimization are presented and the fabrication process discussed.

Numerical Simulation of Wall Shear Stress Conditions and Platelet Localization in Realistic End-to-Side Arterial Anastomoses

2003 ◽  
Vol 125 (5) ◽  
pp. 671-681 ◽  
Author(s):  
P. Worth Longest ◽  
Clement Kleinstreuer
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Bypass Graft ◽  
Self Regulation ◽  
Suture Line ◽  
Cellular Level ◽  
Vascular Surface ◽  
Wall Shear ◽  
Wall Interactions ◽  
Near Wall

Research studies over the last three decades have established that hemodynamic interactions with the vascular surface as well as surgical injury are inciting mechanisms capable of eliciting distal anastomotic intimal hyperplasia (IH) and ultimate bypass graft failure. While abnormal wall shear stress (WSS) conditions have been widely shown to affect vascular biology and arterial wall self-regulation, the near-wall localization of critical blood particles by convection and diffusion may also play a significant role in IH development. It is hypothesized that locations of elevated platelet interactions with reactive or activated vascular surfaces, due to injury or endothelial dysfunction, are highly susceptible to IH initialization and progression. In an effort to assess the potential role of platelet-wall interactions, experimentally validated particle-hemodynamic simulations have been conducted for two commonly implemented end-to-side anastomotic configurations, with and without proximal outflow. Specifically, sites of significant particle interactions with the vascular surface have been identified by a novel near-wall residence time (NWRT) model for platelets, which includes shear stress-based factors for platelet activation as well as endothelial cell expression of thrombogenic and anti-thrombogenic compounds. Results indicate that the composite NWRT model for platelet-wall interactions effectively captures a reported shift in significant IH formation from the arterial floor of a relatively high-angle (30 deg) graft with no proximal outflow to the graft hood of a low-angle graft (10 deg) with 20% proximal outflow. In contrast, other WSS-based hemodynamic parameters did not identify the observed system-dependent shift in IH formation. However, large variations in WSS-vector magnitude and direction, as encapsulated by the WSS-gradient and WSS-angle-gradient parameters, were consistently observed along the IH-prone suture-line region. Of the multiple hemodynamic factors capable of eliciting a hyperplastic response at the cellular level, results of this study indicate the potential significance of platelet-wall interactions coinciding with regions of low WSS in the development of IH.

Relative Contribution of Wall Shear Stress and Injury in Experimental Intimal Thickening at PTFE End-to-Side Arterial Anastomoses

2001 ◽  
Vol 124 (1) ◽  
pp. 44-51 ◽  
Author(s):  
Francis Loth ◽  
Steven A. Jones ◽  
Christopher K. Zarins ◽  
Don P. Giddens ◽  
Raja F. Nassar ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Bypass Graft ◽  
Suture Line ◽  
Computer Assisted ◽  
Ptfe Graft ◽  
Intimal Thickening ◽  
Relative Contribution ◽  
Wall Shear

Background : Intimal hyperplastic thickening (IHT) is a frequent cause of prosthetic bypass graft failure. Induction and progression of IHT is thought to involve a number of mechanisms related to variation in the flow field, injury and the prosthetic nature of the conduit. This study was designed to examine the relative contribution of wall shear stress and injury to the induction of IHT at defined regions of experimental end-to-side prosthetic anastomoses. Methods and Results: The distribution of IHT was determined at the distal end-to-side anastomosis of seven canine Iliofemoral PTFE grafts after 12 weeks of implantation. An upscaled transparent model was constructed using the in vivo anastomotic geometry, and wall shear stress was determined at 24 axial locations from laser Doppler anemometry measurements of the near wall velocity under conditions of pulsatile flow similar to that present in vivo. The distribution of IHT at the end-to-side PTFE graft was determined using computer assisted morphometry. IHT involving the native artery ranged from 0.0±0.1 mm to 0.05±0.03 mm. A greater amount of IHT was found on the graft hood (PTFE) and ranged from 0.09±0.06 to 0.24±0.06 mm. Nonlinear multivariable logistic analysis was used to model IHT as a function of the reciprocal of wall shear stress, distance from the suture line, and vascular conduit type (i.e. PTFE versus host artery). Vascular conduit type and distance from the suture line independently contributed to IHT. An inverse correlation between wall shear stress and IHT was found only for those regions located on the juxta-anastomotic PTFE graft. Conclusions: The data are consistent with a model of intimal thickening in which the intimal hyperplastic pannus migrating from the suture line was enhanced by reduced levels of wall shear stress at the PTFE graft/host artery interface. Such hemodynamic modulation of injury induced IHT was absent at the neighboring artery wall.

Can the Wall Shear Stress Values of Left Internal Mammary Artery Grafts during the Perioperative Period Reflect the One-Year Patency?

2020 ◽  
Vol 68 (08) ◽  
pp. 723-729
Author(s):  
Lan Zhu ◽  
Zilai Pan ◽  
Zehang Li ◽  
Yunxiao Chang ◽  
Yunpeng Zhu ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Internal Mammary Artery ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Perioperative Period ◽  
Distal Segment ◽  
Internal Mammary ◽  
Wall Shear ◽  
One Year

Abstract Purpose The left internal mammary artery (LIMA) is the preferred graft for coronary artery bypass grafting, but the reasoning for LIMA occlusion is unclear. We sought to examine whether the wall shear stress (WSS) values of LIMA grafts during the perioperative period reflected the 1-year patency by using combining computational fluid dynamics (CFD) and coronary computed tomography angiography (CCTA) images. Methods CCTA was performed in 233 patients with LIMA graft perioperatively and 1 year later from October 2014 to May 2017. LIMA occlusion was detected in six patients at the 1-year follow-up CCTA. Two patients were excluded due to poor imaging quality. The remaining four patients were enrolled as occlusive (OCC) group, and eight patients with patent LIMA were recruited as patent (PAT) group. The WSS values of LIMA during perioperative period were calculated. LIMA graft was artificially divided into three even segments, proximal (pLIMA), middle (mLIMA) and distal (dLIMA) segments. The independent samples t-test and the Student–Newman–Keuls test were used. Results The WSS values of dLIMA were significantly higher in the PAT group than in the OCC group (4.43 vs. 2.56, p < 0.05). The WSS values of dLIMA in the PAT group were significantly higher than pLIMA, which was absent in the OCC group. Conclusions A higher WSS value of the distal segment of LIMA and a higher WSS value of the distal segment compared with the proximal segment of LIMA in the PAT were observed; this tendency might be helpful in predicting the 1-year patency of LIMA.

Numerical investigations of various aspects of plaque deposition through constricted artery

2019 ◽  
Vol 13 (3) ◽  
pp. 5306-5322
Author(s):  
P. Goswami ◽  
D. K. Mandal ◽  
N. K. Manna ◽  
S. Chakrabarti
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Arterial Disease ◽  
Oscillatory Shear ◽  
Fractional Flow ◽  
Endothelial Lining ◽  
Plaque Deposition ◽  
Simpler Algorithm ◽  
Mechanical Factors ◽  
Wall Shear

The pulsatile blood flow through constricted artery generates fluid mechanical forces on internal layer of artery, endothelium. These fluid mechanical factors affect endothelial lining from keeping artery healthy. In this paper, a series of numerical simulations of modeled bell shaped stenosed artery have been carried out for investigation of fluid mechanical factors of realistic pulsatile flow at the inlet of modeled stenosis with bell shaped geometry. The governing equations for two-dimensional unsteady laminar flow of incompressible fluid are solved by finite volume method followed by SIMPLER algorithm. The fluid mechanical factors, particularly wall pressure, streamline contour, peak wall shear stress, low wall shear stress and oscillatory shear index, having inferences to the arterial disease, are investigated by simulation results of different percentage of restrictions. All these parameters have a noticeable impact for the plaque deposition. The impacts of Reynolds number and Womersley number for both of mild stenosis and severe stenosis on arterial disease, atherosclerosis are also investigated by evaluating fractional flow reverse and oscillatory shear potential.

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