The effect of proximal artery flow on the hemodynamics at the distal anastomosis of a vascular bypass graft: computational study.

The formation of distal anastomotic intimal hyperplasia (IH), one common mode of bypass graft failure, has been shown to occur in the areas of disturbed flow particular to this site. The nature of theflow in the segment of artery proximal to the distal anastomosis varies from case to case depending on the clinical situation presented. A partial stenosis of a bypassed arterial segment may allow residual prograde flow through the proximal artery entering the distal anastomosis of the graft. A complete stenosis may allow for zero flow in the proximal artery segment or retrograde flow due to the presence of small collateral vessels upstream. Although a number of investigations on the hemodynamics at the distal anastomosis of an end-to-side bypass graft have been conducted, there has not been a uniform treatment of the proximal artery flow condition. As a result, direct comparison of results from study to study may not be appropriate. The purpose of this work was to perform a three-dimensional computational investigation to study the effect of the proximal artery flow condition (i.e., prograde, zero, and retrograde flow) on the hemodynamics at the distal end-to-side anastomosis. We used the finite volume method to solve the full Navier-Stokes equations for steady flow through an idealized geometry of the distal anastomosis. We calculated the flow field and local wall shear stress (WSS) and WSS gradient (WSSG) everywhere in the domain. We also calculated the severity parameter (SP), a quantification of hemodynamic variation, at the anastomosis. Our model showed a marked difference in both the magnitude and spatial distribution of WSS and WSSG. For example, the maximum WSS magnitude on the floor of the artery proximal to the anastomosis for the prograde and zero flow cases is 1.8 and 3.9 dynes/cm2, respectively, while it is increased to 10.3 dynes/cm2 in the retrograde flow case. Similarly, the maximum value of WSSG magnitude on thefloor of the artery proximal to the anastomosis for the prograde flow case is 4.9 dynes/cm3, while it is increased to 13.6 and 24.2 dynes/cm3, respectively, in the zero and retrograde flow cases. The value of SP is highest for the retrograde flow case (13.7 dynes/cm3) and 8.1 and 12.1 percent lower than this for the prograde (12.6 dynes/cm3) and zero (12.0 dynes/cm3) flow cases, respectively. Our model results suggest that the flow condition in the proximal artery is an important determinant of the hemodynamics at the distal anastomosis of end-to-side vascular bypass grafts. Because hemodynamic forces affect the response of vascular endothelial cells, the flow situation in the proximal artery may affect IH formation and, therefore, long-term graft patency. Since surgeons have some control over the flow condition in the proximal artery, results from this study could help determine which flow condition is clinically optimal.

A theoretical model study of the influence of fluid stresses on a cell adhering to a microchannel wall.

We predict the amplification of mechanical stress, force, and torque on an adherent cell due to flow within a narrow microchannel. We model this system as a semicircular bulge on a microchannel wall, with pressure-driven flow. This two-dimensional model is solved computationally by the boundary element method. Algebraic expressions are developed by using forms suggested by lubrication theory that can be used simply and accurately to predict the fluid stress, force, and torque based upon the fluid viscosity, muoffhannel height, H, cell size, R, and flow rate per unit width, Q2-d. This study shows that even for the smallest cells (gamma = R/H << 1), the stress, force, and torque can be significantly greater than that predicted based on flow in a cell-free system. Increased flow resistance and fluid stress amplification occur with bigger cells (gamma > 0.25), because of constraints by the channel wall. In these cases we find that the shear stress amplification is proportional to Q2-d(1-gamma)-2, and the force and torque are proportional to Q2-d(1-gamma2)-5/2. Finally, we predict the fluid mechanical influence on three-dimensional immersed objects. These algebraic expressions have an accuracy of approximately 10% for flow in channels and thus are useful for the analysis of cells in flow chambers. For cell adhesion in tubes, the approximations are accurate to approximately 25% when gamma > 0.5. These calculations may thus be used to simply predict fluid mechanical interactions with cells in these constrained settings. Furthermore, the modeling approach may be useful in understanding more complex systems that include cell deformability and cell-cell interactions.