Biomechanics and Modeling in Mechanobiology

, Volume 18, Issue 4, pp 883–896 | Cite as

Tortuosity of the superficial femoral artery and its influence on blood flow patterns and risk of atherosclerosis

  • Xuanyu Li
  • Xiaosheng Liu
  • Xiao Li
  • Lijian Xu
  • Xin Chen
  • Fuyou LiangEmail author
Original Paper


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.


Superficial 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.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
  2. 2.Collaborative Innovation Center for Advanced Ship and Deep-Sea Exploration (CISSE)Shanghai Jiao Tong UniversityShanghaiChina
  3. 3.Department of Radiology, Renji HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  4. 4.Institute for Personalized MedicineSechenov UniversityMoscowRussia

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