The effect of proximal artery flow on the hemodynamics at the distal anastomosis of a vascular bypass graft: Computational study

被引:56
作者
Kute, SH
Vorp, DA
机构
[1] Univ Pittsburgh, Dept Surg, Pittsburgh, PA 15213 USA
[2] Univ Pittsburgh, Dept Bioengn, Pittsburgh, PA 15213 USA
[3] Univ Pittsburgh, Dept Mech Engn, Pittsburgh, PA 15213 USA
来源
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME | 2001年 / 123卷 / 03期
关键词
D O I
10.1115/1.1374203
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
The formation of distal anastomotic intimal hyperplasia (IH), one common mode of bypass graft failure, has been shown To occur in the areas of disturbed flow particular to this sire. The nature of the flow in the segment of artery proximal to the distal anastomosis varies from case to case depending on the clinical situation presented A partial stenosis of a bypassed arterial segment may allow residual prograde flow through the proximal artery entering the distal anastomosis of the graft. A complete stenosis may allow for zero flow in the proximal artery segment or retrograde flow due to the presence of small collateral vessels upstream. Although a number of investigations an the hemodynamics at the distal anastomosis of an end-to-side bypass graft have been conducted, there has not been a uniform treatment of the proximal artery flow condition. As a result, direct comparison of results from study to study may nor be appropriate. The purpose of this work was to perform a three-dimensional computational investigation to study the effect of the proximal artery flow condition (i.e., prograde, zero, and retrograde flow) on the hemodynamics at the distal end-to-side anastomosis. We used the finite volume method to solve the full Navier-Stokes equations for steady flow through an idealized geometry of the distal anastomosis. We calculated the flow field and local wall shear stress (WSS) and WSS gradient (WSSG) everywhere in the domain, We also calculated the severity parameter (SP), a quantification of hemodynamic variation, at the anastomosis. Our model showed a marked difference in both the magnitude and spatial distribution of WSS and WSSG. For example, the maximum WSS magnitude on the floor of the artery proximal to the anastomosis for the prograde and zero flow cases is 1.8 and 3.9 dynes/cm(2), respectively, while it is increased to 10.3 dynes/cm(2) in the retrograde flow case, Similarly: the maximum value of WSSG magnitude on the floor of the artery proximal to the anastomosis for the prograde pou case is 4.9 dynes/cm(3), while it is increased to 13.6 and 24.2 dynes/cm(3), respectively, in the zero and retrograde flow cases. The value of SP is highest for the retrograde flow case (13.7 dynes/cm(3)) and 8.1 and 12.1 percent lower than this for the prograde (12.6 dynes/cm(3)) and zero (12.0 dynes/cm(3)) flow cases, respectively. Our model results suggest that the flow condition in the proximal artery is an important determinant of the hemodynamics at the distal anastomosis of end-to-side vascular bypass grafts. Because hemodynamic forces affect the response of vascular endothelial cells, the flow situation in the proximal artery may affect IH formation and, therefore, long-term graft patency. Since surgeons have some control over the flow: condition in the proximal artery, results from this study could help determine which flow condition is clinically optimal.
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收藏
页码:277 / 283
页数:7
相关论文
共 42 条
[21]   Flow input waveform effects on the temporal and spatial wall shear stress gradients in a femoral graft-artery connector [J].
Kleinstreuer, C ;
Lei, M ;
Archie, JP .
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, 1996, 118 (04) :506-510
[22]   Hemodynamic simulations and computer aided designs of graft-artery junctions [J].
Lei, M ;
Kleinstreuer, C ;
Archie, JP .
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, 1997, 119 (03) :343-348
[23]   Computational design of a bypass graft that minimizes wall shear stress gradients in the region of the distal anastomosis [J].
Lei, M ;
Archie, JP ;
Kleinstreuer, C .
JOURNAL OF VASCULAR SURGERY, 1997, 25 (04) :637-646
[24]  
Li XM, 1999, AM SOC MECH ENG BIOE, V42, P225
[25]   Focal expression of angiotensin II type 1 receptor and smooth muscle cell proliferation in the neointima of experimental vein grafts - Relation to Eddy blood flow [J].
Liu, SQ .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 1999, 19 (11) :2630-2639
[26]   DOWNSTREAM ANASTOMOTIC HYPERPLASIA - A MECHANISM OF FAILURE IN DACRON ARTERIAL GRAFTS [J].
LOGERFO, FW ;
QUIST, WC ;
NOWAK, MD ;
CRAWSHAW, HM ;
HAUDENSCHILD, CC .
ANNALS OF SURGERY, 1983, 197 (04) :479-483
[27]   Measurements of velocity and wall shear stress inside a PTFE vascular graft model under steady flow conditions [J].
Loth, F ;
Jones, SA ;
Giddens, DP ;
Bassiouny, HS ;
Glagov, S ;
Zarins, CK .
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, 1997, 119 (02) :187-194
[28]   Control of endothelial cell gene expression by flow [J].
Malek, AM ;
Izumo, S .
JOURNAL OF BIOMECHANICS, 1995, 28 (12) :1515-+
[29]   A numerical study of blood flow patterns in anatomically realistic and simplified end-to-side anastomoses [J].
Moore, JA ;
Steinman, DA ;
Prakash, S ;
Johnston, KW ;
Ethier, CR .
JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, 1999, 121 (03) :265-272
[30]   Vascular endothelial cells respond to spatial gradients in fluid shear stress by enhanced activation of transcription factors [J].
Nagel, T ;
Resnick, N ;
Dewey, CF ;
Gimbrone, MA .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 1999, 19 (08) :1825-1834