Experimental study of the POP technique: focus on the physical basis of the process.

INTRODUCTION: Central or peripheral vascular access devices have been in use for many decades. However, despite adequate care and maintenance, complete occlusion may occur, and its impact cannot be overlooked. A new procedure using a percussion technique has been published and referred as 'the POP technique'. METHODS: A hydrodynamic bench was used permitting both the recording of the movement of the piston with a fast camera and the pressure variations in the polyurethane and silicone catheters while connected to 2- and 3-piece syringes. RESULTS: The results are twofold. First the upward movement of the piston leads to the installation of a saturation vapour pressure in the body of the syringe. During this sequence, the clot is submitted to a force of aspiration. Then the release of the plunger leads to a pulse pressure whose dynamics and intensity are dependent of the types of syringes and catheters. CONCLUSIONS: The experiments bring to light the importance of practical features such as the orientation of the syringe and the nature of the polyurethane or silicone catheters. Then the analysis enables the definition of practical rules for safe practice of the POP technique. This study will impact clinicians as many may be tempted to use the technique in hope to resolve the occlusion safely, in a timely manner.

Direct imaging of capillaries reveals the mechanism of arteriovenous interlacing in the chick chorioallantoic membrane.

Understanding vascular development in vertebrates is an important scientific endeavor. Normal vasculatures generally start off as a disorganized capillary lattice which progressively matures into a well-organized vascular loop comprising a hierarchy of arteries and veins. One striking feature of vascular development is the interlacing of arteries and veins. How arteries and veins manage to avoid themselves and interlace with such a perfect architecture is not understood. Here we present a detailed view of the development of the vasculature in the chorioallantoic membrane of the chicken embryo. We find that the origin of arteriovenous interlacing lies in the presence of an increased hemodynamic resistance at the distal part of the arteries due to vascular flattening onto the ectodermal surface. This reduces the vascular conductance distally, thus repelling veins away. In more proximal parts, vessels round off into cylinders and the increased flow attracts veins.

Rheological changes after stenting of a cerebral aneurysm: a finite element modeling approach.

Hemodynamic changes in intracranial aneurysms after stent placement include the appearance of areas with stagnant flow and low shear rates. We investigated the influence of stent placement on blood flow velocity and wall shear stress of an intracranial aneurysm using a finite element modeling approach. To assess viscosity changes induced by stent placement, the rheology of blood as non-Newtonian fluid was taken into account in this model. A two-dimensional model with a parent artery, a smaller branching artery, and an aneurysm located at the bifurcation, before and after stent placement, was used for simulation. Flow velocity plots and wall shear stress before and after stent placement was calculated over the entire cardiac circle. Values for dynamic viscosity were calculated with a constitutive equation that was based on experimental studies and yielded a viscosity, which decreases as the shear rate increases. Stent placement lowered peak velocities in the main vortex of the aneurysm by a factor of at least 4 compared to peak velocities in the main artery, and it considerably decreased the wall shear stress of the aneurysm. Dynamic viscosity increases after stent placement persisted over a major part of the cardiac cycle, with a factor of up to 10, most pronounced near the dome of the aneurysm. Finite element modeling can offer insight into rheological changes induced by stent treatment of aneurysms and allows visualizing dynamic viscosity changes induced by stent placement.

A new ultrasound principle for characterizing erythrocyte aggregation: in vitro reproducibility and validation.

RATIONALE AND OBJECTIVES: There is no method currently available to quantify erythrocyte aggregation in vivo. In this work, using a Couette system, we defined new ultrasound indexes potentially applicable for non-invasive investigations. METHODS: Two ultrasound protocols were developed: (1) a protocol in which decreasing shear rates ranging from 200 to 1 s-1 were applied to solutions; and (2) a protocol in which a 200 s-1 shear rate was initially applied followed by stoppage of flow (a kinetics protocol). New ultrasound indexes were defined as: the power PUS at the nominal frequency of each transducer, Rayleigh's slope (tangent of the curve PUS = f(log(F)) through the 3.5 to 15 MHz frequency bandwidth) and kinetic indexes characterizing the aggregation/aggregability of the suspension. RESULTS: Using washed erythrocytes resuspended in saline, it was shown that the ultrasound intensity is dependent at 3.54 +/- 5.9% (NS) to the power of the frequency (theoretical value = 4). Using 10 total blood samples extracted from a single pig, good reproducibility for all indexes (5%) was demonstrated. CONCLUSIONS: A suitable and reproducible methodology was developed and validated for studying erythrocyte aggregation in calibrated in vitro conditions.