Abstract
This study was concerned with investigating the influence of mechanical factors on the hemodynamics of the end-to-side anastomosis in an attempt to identify critical factors and establish if it is possible to re-engineer existing, patient-specific, by-pass grafts with a view to increasing their patency. The study chose the femoral artery as the principal subject of interest. Wall shear stresses (WSS) and wall shear stress gradients (WSSG) were taken as the primary quantities of interest. Angle, graft calibre, interposition cuffs, proximal outflow and inlet waveform were studied. The study found that the use of cuffs and patches can significantly reduce abnormal WSS and WSSG by up to 70% when compared to a benchmark 45∘ conventional anastomosis. The Taylor patch was found to be more robust in reducing peak WSS magnitudes and gradients than the Miller cuff, where design variables proved to be more critical. On the addition of a Taylor patch to a realistic end-to-side femoral anastomosis, the peak WSS and WSSG were found to be reduced by 27% and 57%, respectively. In conclusion, it is possible to use idealised models to identify critical disease influencing factors and to use these findings to reduce the effects of abnormal hemodynamics in realistic, patient-dependant models.
Similar content being viewed by others
References
Ballyk, P. D., C. Walsh, J. Butany, and M. Ojha. Compliance mismatch may promote graft-artery intimal hyperplasia by altering suture-line stresses. J. Biomech. 31:229–237, 1998.
Buchanan, J. R., C. Kleinstreuer, and J. K. Comer. Rheological effects on pulsatile hemodynamics in a stenosed tube. Comput. Fluids 29:695–724, 2000.
Caro, C. G., et al. Atheroma and arterial wall observations, correlation and proposal of a shear dependant mass transfer mechanism for atherogenesis. Proceedings of the Royal Society of London, Series B, 177:109–159, 1971.
Cheshire N. J., M. A. Noone, and J. H. Wolfe. How to select the treatment of choice of critical leg ischemia. Ann. Chir Gyn. 81(2):141–152, 1992.
Cole, J. S., J. K. Watterson, and M. J. G. O’Reilly. Numerical investigations of the hemodynamics at a patched arterial bypass anastomosis. Med. Eng. Phys. 24:393–401, 2002.
Defrang, R. D., J. M. Edwards, G. L. Moneta, R. A. Yeager, L. M. Taylor, and J. M. Porter. Repeat leg bypass after multiple bypass failures. J. Vasc. Surg. 19:268–277, 1994.
Ducasse, E., L. Fleurisse, G. Vernier, F. Speziale, P. Fiorani, P. Puppinck, and C. Creusy. Interposition vein cuff and intimal hyperplasia: An experimental study. Eur. J. Vasc. Endovasc. Surg. 27(6):617–621, 2004.
Eagleton, M. J., K. Ouriel, C. Shortell, and R. M. Green. Femoral-infrapopliteal bypass with prosthetic grafts. Surgery 26(4):759–764, 1999.
Ethier, C. R., D. A. Steinman, X. Zhang, S. R. Karpik, and M. Ojha. Flow waveform effects on end-to-side anastomotic flow patterns’. J. Biomech. 31:609–617, 1998.
Fatemi, R. S., and S. E. Rittgers. Derivation of shear rates from near-wall LDA measurements under steady and pulsatile flow conditions. J. Biomech. Eng. 116:361–367, 1994.
Fei, D. Y., J. D. Thomas, and S. E. Rittgers. The effect of angle and flow rate upon hemodynamics in distal vascular graft anastomoses: A numerical model. J. Biomech. Eng. 116:331–336, 1994.
Fichelle, J. M., J. Marzelle, G. Colacchio, et al. Infrapopliteal polytetrafluoroethylene and composite bypass: Factors influencing patency. Ann. Vasc. Surg. 9(2):187–196, 1995.
Fry, D. L. Responses of the arterial wall to certain physical factors. In: Atherosclerosis: Initiating Factors, edited by R. Porter and J. Knight. Amsterdam: Associated Scientific Publisher, 1973, pp. 93–125.
Fung, Y. C. Biomechanics Circulation, 2nd ed. New York: Springer, 1997.
Hayashi, K., Y. Yanai, and T. Naiki. A 3D LDA study of the relation between WSS and intimal hyperplasia in a human aortic bifurcation. J. Biomech. Eng. 118:273–279, 1996.
Hazel, A. L., and T. J. Pedley. Alteration of mean wall shear stress near an oscillating stagnation point. J. Biomech. Eng. 120:227–237, 1998.
Henry, F. S., M. W. Collins, P. E. Hughes, and T. V. How. Numerical investigation of steady flow in proximal and distal end-to-side anastomoses’. J. Biomech. Eng. 118:302–310, 1996.
Henry, F. S., C. Kupper, and N. P. Lewington. Simulation of flow through a Miller cuff bypass. Comput. Methods Biomech. Bioeng. 5(3):207–217, 2002.
Hofer, M., G. Rappitsch, K. Perktold, W. Trubel, and H. Schima. Numerical study of wall mechanics and fluid dynamics in end-to-side anastomoses and correlation to intimal hyperplasia. J. Biomech. 29(10):1297–1308, 1996.
Hughes, P. E., and T. V., How. Effects of geometry and flow division on flow structures in models of the distal end-to-side anastomosis. J. Biomech. 29(7):855–872, 1996.
Jones, S. A., D. P. Giddens, F. Loth, C. K. Zarins, F. Kajiya, I. Morita, O. Hiramatsu, K. Ogasawara, and K. Tsujioka. In vivo measurements of blood flow velocity profiles in canine ilio-femoral anastomotic bypass grafts. J. Biomech. Eng. 119:30–38, 1997.
Keynton, R. S., S. E. Rittgers, and M. C. S. Shu. The effect of angle and flow-rate upon hemodynamics in distal vascular graft anastomoses: An in vitro model study. J. Biomech. Eng. 113:458–463, 1991.
Kreienberg, P. B., R. C. Darling, B. B. Chang, P. S. Paty, W. E. Lloyd, and D. M. Shah. Adjunctive techniques to improve patency of distal prosthetic bypass grafts: Polytetrafluoroethylene with remote arteriovenous fistulae versus vein cuffs. J. Vasc. Surg. 31(4):696–701, 2000.
Kute, S. M., and D. A. Vorp. The effect of proximal artery flow on the hemodynamics at the distal anastomosis of a vascular bypass graft: Computational study. J. Biomech. Eng. 123:277–283, 2001.
Lei, M. Computational fluid dynamics analyses and optimal design of bifurcating blood vessels. PhD Thesis, North Carolina State University Press, 1995.
Lei, M., C. Kleinstreuer, and J. P. Archie. Geometric design improvements for femoral graft-artery junctions mitigating restenosis. J. Biomch. 29(12):1605–1614, 1995.
Lei, M., J. P. Archie, and C. Kleinstreuer. Computational design of a bypass graft that minimises wall shear stress gradients in the region of the distal anastomosis. J. Vasc. Surg. 25(4):637–646, 1997.
Leuprecht, A., K. Perktold, M. Prosi, T. Berk, W. Trubel, and H. Schima. Numerical study of hemodynamics and wall mechanics in distal end-to-side anastomoses of by-pass grafts. J. Biomch. 35:225–236, 2002.
Li, X. M., and S. E. Rittgers. Hemodynamics factors at the distal end-to-side anastomosis of a bypass graft with different POS: DOS flow ratios. J. Biomech. Eng. 123:270–276, 2001.
Longest, P. W., C. Kleinstreuer, and J. P. Archie Jr. Particle hemodynamics analysis of Miller cuff arterial anastomosis. J. Vasc. Surg. 38(6):1353–1362, 2003.
Loth, F., S. A. Jones, C. K. Zarins, D. P. Giddens, R. F. Nassar, S. Glagov, and H. S. Bassiouny. Relative contribution of wall shear stress and injury in experimental intimal thickening at ePTFE end-to-side arterial anastomoses. J. Biomech. Eng. 124:44–51, 2002.
Madiba, T. E., M. Mars, and J. V. Robbs. Choosing the proximal anastomosis in aortobifemoral bypass. Br. J. Surg. 84(10): 1416–1418, 1997.
Moore, J. A., D. A. Steinman, S. Prakash, K. W. Johnston, and C. R. Ethier. A numerical study of blood flow patterns in anatomically realistic and simplified end-to-side anastomoses. J. Biomech. Eng. 121:265–272, 1999.
Morris, L., Numerical and Experimental Investigation of Mechanical Factors in the Treatment of Abdominal Aortic Aneurysms. PhD Thesis, University of Limerick Press, 2004.
Nichols, W. W., and M. F. O’Rourke ‘McDonalds blood Flow in arteries,’ 4th ed. Arnold, 1998.
Noori, N., R. Scherer, K. Perktold, M. Czerny, G. Karner, W. Trubel, P. Polterauer, and H. Schima. Blood flow in a distal ESA with PTFE and a venous patch: Results of an in vitro flow visualisation study. Eur. J. Vasc. Endovasc. Surg. 18:191–200, 1999.
Papaharilaou, Y., D. J. Doorly, and S. J. Sherwin. The influence of out-of-plane geometry on pulsatile flow within a distal end-to-side anastomosis. J. Biomch. 35:1225–1239, 2002.
da Silva, A. F., T. Carpenter, T. V. How, and P. L. Harris. Stable vortices within vein cuffs inhibit anastomotic myointimal hyperplasia. Eur. J. Vasc. Endovasc. Surg. 14:157–163, 1997.
Steinman, D. A., B. Vinh, C. R. Ethier, M. Ojha, R. S. C. Cobbold, and K. W. Johnston. A numerical simulation of flow in a two-dimensional end-to-side anastomosis model. J. Biomech. Eng. 115:112–118, 1993.
Trubel, W., H. Schima, M. Czerny, K. Perktold, M. G. Schimek, and P. Polterauer. Experimental comparison of four methods of end-to-side anastomosis with expanded polytetrafluoroethylene. Br. J. Surg. 91(2):159–167, 2004.
Walsh, M. T., E. G. Kavanagh, T. O’Brien, P. A. Grace, and T. McGloughlin. On the existence of an optimum end-to-side junctional geometry in peripheral bypass surgery—A computer generated study. Eur. J. Vasc. Endovasc. Surg. 26:649–656, 2003.
Walsh, M., T. McGloughlin, D. W. Liepsch, T. O’Brien, L. Morris, and A. R. Ansari. On using experimentally estimated wall shear stresses to validate numerically predicted results. Proc. Instn. Mech. Engrs 217(H):77–90.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brien, T.O., Walsh, M. & McGloughlin, T. On Reducing Abnormal Hemodynamics in the Femoral End-to-Side Anastomosis: The Influence of Mechanical Factors. Ann Biomed Eng 33, 310–322 (2005). https://doi.org/10.1007/s10439-005-1733-y
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10439-005-1733-y