Document Detail


A longitudinal study of remodeling in a revised peripheral artery bypass graft using 3D ultrasound imaging and computational hemodynamics.
MedLine Citation:
PMID:  21428682     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We report a study of the role of hemodynamic shear stress in the remodeling and failure of a peripheral artery bypass graft. Three separate scans of a femoral to popliteal above-knee bypass graft were taken over the course of a 16 month period following a revision of the graft. The morphology of the lumen is reconstructed from data obtained by a custom 3D ultrasound system. Numerical simulations are performed with the patient-specific geometries and physiologically realistic flow rates. The ultrasound reconstructions reveal two significant areas of remodeling: a stenosis with over 85% reduction in area, which ultimately caused graft failure, and a poststenotic dilatation or widening of the lumen. Likewise, the simulations reveal a complicated hemodynamic environment within the graft. Preliminary comparisons with in vivo velocimetry also showed qualitative agreement with the flow dynamics observed in the simulations. Two distinct flow features are discerned and are hypothesized to directly initiate the observed in vivo remodeling. First, a flow separation occurs at the stenosis. A low shear recirculation region subsequently develops distal to the stenosis. The low shear region is thought to be conducive to smooth muscle cell proliferation and intimal growth. A poststenotic jet issues from the stenosis and subsequently impinges onto the lumen wall. The lumen dilation is thought to be a direct result of the high shear stress and high frequency pressure fluctuations associated with the jet impingement.
Authors:
Patrick M McGah; Daniel F Leotta; Kirk W Beach; James J Riley; Alberto Aliseda
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Journal of biomechanical engineering     Volume:  133     ISSN:  1528-8951     ISO Abbreviation:  J Biomech Eng     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-03-24     Completed Date:  2011-07-29     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  7909584     Medline TA:  J Biomech Eng     Country:  United States    
Other Details:
Languages:  eng     Pagination:  041008     Citation Subset:  IM    
Affiliation:
Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA. pmcgah@u.washington.edu
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MeSH Terms
Descriptor/Qualifier:
Computer Simulation*
Constriction, Pathologic / physiopathology,  ultrasonography
Femoral Artery / physiopathology,  surgery*,  ultrasonography
Hemodynamics*
Humans
Imaging, Three-Dimensional*
Longitudinal Studies
Popliteal Artery / physiopathology,  surgery*,  ultrasonography
Prosthesis Failure
Retrospective Studies
Stress, Mechanical
Vascular Grafting / methods*
Grant Support
ID/Acronym/Agency:
R21 DK 081823/DK/NIDDK NIH HHS; R21 DK081823-01/DK/NIDDK NIH HHS; R21 DK081823-02/DK/NIDDK NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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