Abstract
A number of research studies have related multiple hemodynamic parameters to the formation of distal anastomotic intimal hyperplasia (IH) at the sub-cellular, cellular, and tissue levels. Focusing on mitigating WSS-based parameters alone, several studies have suggested geometrically modified end-to-side anastomoses with the intent of improving synthetic graft patency rates. However, recent clinical trials of commercially available versions of these grafts indicate persistently high rates of failure. Furthermore, recent evidence suggests that platelet-wall interactions may play a significant role in the formation of IH, which is not captured by WSS-based parameters alone. In this study, numerical simulations have been conducted to assess the potential for IH formation in conventional and geometrically modified anastomoses based on both wall shear stress (WSS) conditions and platelet-wall interactions. Sites of significant particle-wall interactions, including elevated concentrations and stasis, were identified by a near-wall residence time model, which includes factors for platelet activation and surface reactivity. Conventional, pre-cuffed, and streamlined distal end-to-side anastomoses were considered with proximal and distal arterial outflow. It was found that a pre-cuffed anastomosis, similar to the Distaflo configuration, does not offer a hemodynamic advantage over the conventional design considered with respect to the magnitude of the WSS field and the potential for platelet interactions with the vessel surface. Streamlined configurations largely consistent with venous confluences resulted in an advantageous reduction of wall shear stress gradient values; however, particle-wall interactions remained significant throughout the anastomosis. Results of this study are not intended to be directly extrapolated to surgical recommendations. However, these results highlight the difficulty associated with designing an end-to-side distal anastomosis with two-way outflow that is capable of simultaneously reducing multiple hemodynamic parameters. Further testing will be necessary to determine if the observed elevated particle-wall interactions in a pre-cuffed anastomosis provide the stimulus responsible for the reported high failure rates of these grafts.
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References
Aarts, P. A., P. Steendijk, J. J. Sixma, and R. M. Heethaar. Fluid shear as a possible mechanism for platelet diffusivity in flowing blood. J. Biomech. 19(10):799–805, 1986.
Aarts, P. A., S. A. van den Broek, G. W. Prins, G. D. Kuiken, J. J. Sixma, and R. M. Heethaar. Blood platelets are concentrated near the wall and red blood cells in the center in flowing blood. Arteriosclerosis 8(6):819–824, 1988.
Bassiouny, H. S., S. White, S. Glagov, E. Choi, D. P. Giddens, and C. K. Zarins. Anastomotic intimal hyperplasia: Mechanical injury or flow induced. J. Vasc. Surg. 15:708–717, 1992.
Bertschinger, K., P. C. Cassina, J. F. Debatin, and S. G. Ruehm. Surveillance of peripheral arterial bypass grafts with three-dimensional MR angiography. Am. J. Roentgenol. 176:215–220, 2001.
Buchanan, J. R., and C. Kleinstreuer. Simulation of particle hemodynamics in a partially occluded artery segment with implications to the initiation of microemboli and secondary stenoses. J. Biomech. Eng. 120:446–454, 1998.
Cokelet, G. R. In: Handbook of Bioengineering, edited by R. Skalak and S. Chien. New York: McGraw-Hill, 1987.
Da Silva, A. F., T. Carpenter, T. V. How, and P. L. Harris. Stable vortices within vein cuffs inhibit the anastomotic myointimal hyperplasia? Eur. J. Vasc. Endovasc. Surg. 14:157–163, 1997.
Fisher, R. K., T. V. How, A. Bakran, J. A. Brennan, and P. L. Harris. Outflow distribution at the distal anastomosis of infrainguinal bypass grafts. J. Biomech. 37:417–420, 2004.
Fisher, R. K., T. V. How, I. M. Toonder, M. T. C. Hoedt, J. A. Brennan, G. L. Gilling-Smith, and P. L. Harris. Harnessing haemodynamic forces for the suppression of anastomotic intimal hyperplasia: The rationale for precuffed grafts. Eur. J. Vasc. Endovasc. Surg. 21:520–528, 2001.
Fisher, R. K., U. J. Kirkpatrick, T. V. How, J. A. Brennan, G. L. Gilling-Smith, and L. P. Harris. The Distaflo Graft: A Valid Alternative to Interposition Vein. Eur. J. Vasc. Endovasc. Surg. 25:235–239, 2003.
Fisher, R. K., U. J. Kirkpatrick, T. V. How, J. A. Brennan, G. L. Gilling-Smith, and P. L. Harris. Prospective study of the Distaflo™ graft. Br. J. Surg. 89(4):514, 2002.
Goldsmith, H. L., M. M. Frojmovic, S. Braovac, F. McIntosh, and T. Wong. Adenosine diphosphate-inducted aggregation of human platelets in flow through tubes. III. Shear and extrinsic fibrinogen-dependent effects. Thromb Haemost 71(1):78–90, 1994.
Grabowski, E. F., E. A. Jaffe, and B. B. Weksler. Prostacyclin production by cultured endothelial cell monolayers exposed to step increase in shear stress. J. Lab. Clin. Med. 105:36–43, 1985.
Grabowski, E. F., A. J. Reininger, P. G. Petteruti, O. Tsukurov, and R. W. Orkin. Shear stress decreases endothelial cell tissue factor activity by augmenting secretion of tissue factor pathway inhibitor. Arterioscler. Thromb. Vasc. Biol. 21:157–162, 2001.
Harris, P. L., and T. V. How. Haemodynamics of cuffed arterial anastomoses. Crit. Ischaemia 9(1):20–26, 1999.
Hellums, J. D. 1993 Whitaker Lecture: Biorheology in thrombosis research. Ann. Biomed. Eng. 22(5):445–455, 1994.
Hoedt, M. T. C., H. van Urk, W. C. J. Hop, A. van der Lugt, and C. H. A. Wittens. A comparison of distal end-to-side and end-to-end anastomoses in femoropopliteal bypasses. Eur. J. Vasc. Endovasc. Surg. 21:266–270, 2001.
How, T. V., C. S. Rowe, G. L. Gilling-Smith, and L. Harris. Interposition vein cuff anastomosis alters wall shear stress distribution in the recipient artery. J. Vasc. Surg. 31:1008–1017, 2000.
Karino, T., and H. L. Goldsmith. Flow behaviour of blood cells and rigid spheres in an annular vortex. Philos. Trans. R. Soc. Lon. Ser. B 279:413–445, 1977.
Keynton, R. S., M. M. Evancho, R. L. Sims, and S. E. Rittgers. The effect of graft caliber upon wall shear within in vivo distal vascular anastomoses. ASME J. Biomech. Eng. 121:79–88, 1999.
Keynton, R. S., M. M. Evancho, R. L. Sims, N. V. Rodway, A. Gobin, and S. E. Rittgers. Intimal hyperplasia and wall shear in arterial bypass graft distal anatomoses: An in vivo model study. J. Biomech. Eng. 123:464–473, 2001.
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. ASME J. Biomech. Eng. 113:458–463, 1991.
Kissin, M., N. Kansal, P. J. Pappas, D. O. DeFouw, W. N. Duran, and R. W. Hobson. Vein interpositioned cuffs decrease the intimal hyperplastic response of polytetrafluoroethylene bypass grafts. J. Vasc. Surg. 31:69–83, 2000.
Kleinstreuer, C., S. Hyun, J. R. Buchanan, P. W. Longest, J. P. Archie, and G. A. Truskey. Hemodynamic parameters and early intimal thickening in branching blood vessels. Crit. Rev. Biomed. Eng. 29(1):1–64, 2001.
Lei, M., C. Kleinstreuer, and J. P. Archie. Geometric design improvements for femoral graft-artery junctions mitigating restenosis. J. Biomech. 29(12):1605–1614, 1996.
Lei, M., C. Kleinstreuer, and J. P. Archie. Hemodynamic simulations and computer-aided designs of graft-artery junctions. ASME J. Biomech. Eng. 119:343–348, 1997.
Leuprecht, A., K. Perktold, M. Prosi, T. Berk, W. Trubel, and H. Schima. Numerical study of hemodynamics and wall mechanics in dital end-to-side anastomoses of bypass grafts. J. Biomech. 35:225–236, 2002.
Li, X., and S. E. Rittgers. Hemodynamic factors at the distal end-to-side anastomosis of a bypass graft with different POS:DOS flow ratios. ASME J. Biomech. Eng. 123:270–276, 2001.
Liu, S. Q. Biomechanical basis of vascular tissue engineering. Crit. Rev. Biomed. Eng. 27(1&2):75–148, 1999.
Longest, P. W., and C. Kleinstreuer. Computational haemodynamics analysis and comparison study of arterio-venous grafts. J. Med. Eng. Technol. 24(3):102–110, 2000.
Longest, P. W., and C. Kleinstreuer. Comparison of blood particle deposition models for non-parallel flow domains. J. Biomech. 36(3):421–430, 2003.
Longest, P. W., and C. Kleinstreuer. Numerical simulation of wall shear stress conditions and platelet localization in realistic end-to-side arterial anastomoses. J. Biomech. Eng. Transac. ASME 125(5):671–681, 2003.
Longest, P. W., and C. Kleinstreuer. Particle-hemodynamics modeling of the distal end-to-side femoral bypass: effects of graft caliber and graft-end cut. Med. Eng. Phys. 25(10):843–858, 2003.
Longest, P. W., C. Kleinstreuer, and P. J. Andreotti. Computational analyses and design improvements of graft-to-vein anastomoses. Crit. Rev. Biomed. Eng. 28(1–2):141–147, 2000.
Longest, P. W., C. Kleinstreuer, and J. P. Archie. Particle hemodynamics analysis of Miller cuff arterial anastomosis. J. Vasc. Surg. 38(6):1353–1362, 2003.
Longest, P. W., C. Kleinstreuer, and J. R. Buchanan. Efficient computation of micro-particle dynamics including wall effects. Comput. Fluids 33(4):577–601, 2004.
37ss Longest, P. W., C. Kleinstreuer, G. A. Truskey, and J. R. Buchanan. Relation between near-wall residence times of monocytes and early lesion growth in the rabbit aorto-celiac junction. Ann. Biomed. Eng. 31(1):53–64, 2003.
Loth, F., S. 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 PTFE end-to-side arterial anastomoses. J. Biomech. Eng. 124:44–51, 2002.
Miller, J. H., R. K. Foreman, L. Ferguson, and I. Fads. Interposition vein cuff for anastomosis of prosthesis to small artery. Aust. N. Z. J. Surgery 54:283–285, 1984.
Nielsen, T. G., F. von Jessen, H. Sillesen, and T. V. Schroeder. Doppler spectral characteristics of infrainguinal vein bypasses. Eur. J. Vasc. Surg. 7:610–615, 1993.
Noori, N., R. Scherer, K. Perktold, M. Czerny, G. Karner, W. Trubel, P. Polterauer, and H. Schima. Blood flow in distal end-to-side anastomoses with PTFE and a venous patch: Results of an in vitro flow visualization study. Eur. J. Endovasc. Surg. 18:191–200, 1999.
Ojha, M., C. R. Ethier, K. W. Johnston, and R. S. C. Cobbold. Steady and pulsatile flow fields in an end-to-side arterial anastomosis model. J. Vasc. Surg. 12:747–753, 1990.
Okadome, K., T. Onohara, S. Yamamura, and K. Sugimachi. Intraoperative flow waveform analysis aids in preventing early graft failure following reconstruction of arteries of the legs. Ann. Vasc. Surg. 5:413–418, 1991.
Papanicolaou, G., K. W. Beach, R. E. Zierler, and D. E. Strandness. Systolic flow limitation in stenotic lower-extremity vein grafts. J. Vasc. Surg. 23:394–400, 1996.
Pearson, J. D. Endothelial cell function and thrombosis. Baillieres Clin. Haematol. 7:441–452, 1994.
Perktold, K., A. Leuprecht, M. Prosi, T. Berk, M. Czerny, W. Trubel, and H. Schima. Fluid dynamics, wall mechanics, and oxygent transfer in peripheral bypass anastomoses. Ann. Biomed. Eng. 30:447–460, 2002.
Sorom, A. J., C. B. Hughes, J. T. McCarthy, B. M. Jenson, M. Prieto, and J. M. Panneton. Prospective, randomized evaluation of a cufed expanded polytetrafluoroethylene graft for hemodialysis vascular acess. Surgery 132(2):135–140, 2002.
Sottiurai, V. S. Distal anastomotic intimal hyperplasia: Histocytomorphology, pathophysiology, etiology, and prevention. Int. J. Angiol. 8:1–10, 1999.
Sottiurai, V. S., J. S. T. Yao, R. C. Batson, S. L. Sue, R. Jones, and Y. A. Nakamura. Distal anastomotic intimal hyperplasia: Histopathologic character and biogenesis. Ann. Vasc. Surg. 3(1):26–33, 1989.
Sottiurai, V. S., J. S. T. Yao, W. R. Flinn, and R. C. Batson. Intimal hyperplasia and neointima: An ultrastructural analysis of thrombosed grafts in humans. Surgery 93(6):809–817, 1983.
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. 114:112–118, 1993.
Stonebridge, P. A., R. J. Prescott, and C. V. Ruckley. Randomized trail comparing infrainguinal polytetrafluoroethylene bypass grafting with and without vein interposition cuff at the distal anastomosis. J. Vasc. Surg. 26(4):543–550, 1997.
Taylor, R. S., A. Loh, R. J. McFarland, M. Cox, and I. F. Chester. Improved technique for polytetrafluoroethylene bypass grafting: Long-term results using anastomotic vein patches. Br. J. Surg. 79:348–354, 1992.
Watase, M., J. Kambayashi, T. Itoh, Y. Tsuji, T. Kawasaki, E. Shiba, and M. Hashimoto Sakon, P. H. Ultrastructural analysis of pseudo-intimal hyperplasia of PTFE prostheses implanted into the venous and arterial systems. Eur. J. Vasc. Surg. 6:371–380, 1992.
Westmuckett, A. D., C. Lupu, S. Roquefeuil, T. Krausz, V. V. Kakkar, and F. Lupu. Fluid flow induces upregulation of synthesis and release of tissue factor pathway inhibitor in vitro. Arterioscler. Thromb. Vasc. Biol. 20:2474–2482, 2000.
White, S. S., C. K. Zarins, D. P. Giddens, H. Bassiouny, F. Loth, S. A. Jones, and S. Glagov. Hemodynamic patterns in two models of end-to-side vascular graft anastomoses: effects of pulsatility, Reynolds number and hood length. ASME J. Biomech. Eng. 115:104–111, 1993.
Wootton, D. M., and D. N. Ku. Fluid mechanics of vascular systems, diseases, and thrombosis. Ann. Rev. Biomed. Eng. 10:299–329, 1999.
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Longest, P.W., Kleinstreuer, C. & Deanda, A. Numerical Simulation of Wall Shear Stress and Particle-Based Hemodynamic Parameters in Pre-Cuffed and Streamlined End-to-Side Anastomoses. Ann Biomed Eng 33, 1752–1766 (2005). https://doi.org/10.1007/s10439-005-7784-2
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DOI: https://doi.org/10.1007/s10439-005-7784-2