Tortuosity of the superficial femoral artery and its influence on blood flow patterns and risk of atherosclerosis
- 186 Downloads
The superficial femoral artery (SFA) is a typical atherosclerosis-prone site. We aimed to explore whether the tortuosity of the SFA associates with the occurrence of atherosclerosis and investigate how vascular tortuosity influences the characteristics of blood flow. Ten patients diagnosed with atherosclerotic disease in their SFAs while free of systemic atherosclerosis risk factors were enrolled together with ten atherosclerosis-free patients. The tortuosity of each SFA was quantitatively evaluated by calculating the averaged curvature (AC), maximum curvature (MC) and fraction of high curvature (FC) based on the geometrical model reconstructed from medical images. Hemodynamic studies were performed using both geometrically simplified and anatomically realistic models of the SFA to systematically address the hemodynamic effects of vascular tortuosity. Morphological analyses revealed that all curvature indices of the SFA were significantly larger in patients with atherosclerosis than in atherosclerosis-free patients (AC [mm−1]: 0.034 ± 0.016 vs. 0.018 ± 0.006; MC [mm−1]: 0.055 ± 0.023 vs. 0.034 ± 0.008; FC [%]: 22.77 ± 10.22 vs. 11.39 ± 6.82; p < 0.001). Simulations of blood flows in the geometrically simplified SFAs showed that increasing vascular curvature caused a progressive increase in the area ratios of low wall shear stress (LWSA) and high oscillatory shear index (HOSA). Hemodynamic studies on the anatomically realistic SFAs further demonstrated that high-curvature SFAs (n = 10) had overall larger LWSA and HOSA compared with low-curvature SFAs (n = 10) (LWSA [%]: 4.13 ± 1.91 vs. 1.79 ± 1.13, p = 0.009; HOSA [%]: 4.95 ± 1.92 vs. 2.37 ± 1.51, p = 0.007). These results suggest that increased vascular tortuosity augments the severity and distribution of atherosclerosis-promoting flow disturbances in the SFA and may be an independent risk factor for atherosclerosis.
KeywordsSuperficial femoral artery Tortuosity Atherosclerosis Low wall shear stress High oscillatory shear index
This study was supported in part by the National Natural Science Foundation of China (Grant No. 81611530715) and the SJTU Medical-Engineering Cross-cutting Research Foundation (Grant Nos. YG2015MS53, YG2016MS09).
Compliance with ethical standards
Conflict of interest
The authors have no conflict of interest to declare.
- Cecchi E, Giglioli C, Valente S, Lazzeri C, Gensini GF, Abbate R, Mannini L (2011) Role of hemodynamic shear stress in cardiovascular disease. Atherosclerosis 214(2):249–256. https://doi.org/10.1016/j.atherosclerosis.2010.09.008 CrossRefGoogle Scholar
- Desyatova A, MacTaggart J, Romarowski R, Poulson W, Conti M, Kamenskiy A (2018) Effect of aging on mechanical stresses, deformations, and hemodynamics in human femoropopliteal artery due to limb flexion. Biomech Model Mechanobiol 17(1):181–189. https://doi.org/10.1007/s10237-017-0953-z CrossRefGoogle Scholar
- Diehm N, Shang A, Silvestro A, Do DD, Dick F, Schmidli J, Mahler F, Baumgartner I (2006) Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty. Eur J Vasc Endovasc Surg 31:59–63. https://doi.org/10.1016/j.ejvs.2005.09.006 CrossRefGoogle Scholar
- Dopheide JF, Rubrech J, Trumpp A, Geissler P, Zeller GC, Schnorbus B, Schmidt F, Gori T, Münzel T, Espinola-Klein C (2017) Supervised exercise training in peripheral arterial disease increases vascular shear stress and profunda femoral artery diameter. Eur J Prev Cardiol 24:178–191. https://doi.org/10.1177/2047487316665231 CrossRefGoogle Scholar
- Fowkes FGR, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UKA, Williams LJ, Mensah GA, Criqui MH (2013) Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 382(9901):1329–1340. https://doi.org/10.1016/S0140-6736(13)61249-0 CrossRefGoogle Scholar
- Gerald F, Housley E, Riemersma RA, Macintyre CCA, Cawood EHH, Prescott RJ, Ruckley CV (1992) Smoking, lipids, glucose intolerance, and blood pressure as risk factors for peripheral atherosclerosis compared with ischemic heart disease in the Edinburgh artery study. Am J Epidemiol 135:331–340. https://doi.org/10.1093/oxfordjournals.aje.a116294 CrossRefGoogle Scholar
- Rikhtegar F, Knight JA, Olgac U, Saur SC, Poulikakos D, Marshall W, Cattin PC, Alkadhi H, Kurtcuoglu V (2012) Choosing the optimal wall shear parameter for the prediction of plaque location—a patient-specific computational study in human left coronary arteries. Atherosclerosis 221:432–437. https://doi.org/10.1016/j.atherosclerosis.2012.01.018 CrossRefGoogle Scholar
- Wood NB, Zhao SZ, Zambanini A, Jackson M, Gedroyc W, Thom SA, Hughes AD, Xu XY (2006) Curvature and tortuosity of the superficial femoral artery: a possible risk factor for peripheral arterial disease. J Appl Physiol 101:1412–1418. https://doi.org/10.1152/japplphysiol.00051.2006 CrossRefGoogle Scholar
- Yamamoto T, Tanaka H, Jones CJ, Lever MJ, Parker KH, Kimura A, Hiramatsu O, Ogasawara Y, Tsujioka K, Caro CC (1992) Blood velocity profiles in the origin of the canine renal artery and their relevance in the localization and development of atherosclerosis. Arterioscler Thromb Vasc Biol 12:626–632. https://doi.org/10.1161/01.ATV.12.5.626 CrossRefGoogle Scholar
- Zarins CK, Giddens DP, Bharadvaj BK, Sottiurai VS, Mabon RF, Gladov S, Glagov S (1983) Carotid bifurcation atherosclerosis: quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res 53:502–514. https://doi.org/10.1161/01.RES.53.4.502 CrossRefGoogle Scholar
- Zhu H, Friedman MH (2003) Relationship between the dynamic geometry and wall thickness of a human coronary artery. Arterioscler Thromb Vasc Biol 23(12):2260–2265. https://doi.org/10.1161/01.ATV.0000095976.40874.E0 CrossRefGoogle Scholar