An in silico study of the influence of vessel wall deformation on neointimal hyperplasia progression in peripheral bypass grafts.

Autor: Donadoni F; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK., Bonfanti M; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, W1W 7TS, UK., Pichardo-Almarza C; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK., Homer-Vanniasinkam S; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Leeds Teaching Hospitals NHS Trust, LS1 3EX, UK; Division of Surgery, University of Warwick, Warwick, UK., Dardik A; The Department of Surgery, Yale University School of Medicine, New Haven, CT, USA; Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA., Díaz-Zuccarini V; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, W1W 7TS, UK. Electronic address: v.diaz@ucl.ac.uk.
Jazyk: angličtina
Zdroj: Medical engineering & physics [Med Eng Phys] 2019 Dec; Vol. 74, pp. 137-145. Date of Electronic Publication: 2019 Sep 18.
DOI: 10.1016/j.medengphy.2019.09.011
Abstrakt: Neointimal hyperplasia (NIH) is a major obstacle to graft patency in the peripheral arteries. A complex interaction of biomechanical factors contribute to NIH development and progression, and although haemodynamic markers such as wall shear stress have been linked to the disease, these have so far been insufficient to fully capture its behaviour. Using a computational model linking computational fluid dynamics (CFD) simulations of blood flow with a biochemical model representing NIH growth mechanisms, we analyse the effect of compliance mismatch, due to the presence of surgical stitches and/or to the change in distensibility between artery and vein graft, on the haemodynamics in the lumen and, subsequently, on NIH progression. The model enabled to simulate NIH at proximal and distal anastomoses of three patient-specific end-to-side saphenous vein grafts under two compliance-mismatch configurations, and a rigid wall case for comparison, obtaining values of stenosis similar to those observed in the computed tomography (CT) scans. The maximum difference in time-averaged wall shear stress between the rigid and compliant models was 3.4 Pa, and differences in estimation of NIH progression were only observed in one patient. The impact of compliance on the haemodynamic-driven development of NIH was small in the patient-specific cases considered.
(Copyright © 2019. Published by Elsevier Ltd.)
Databáze: MEDLINE
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