Experimental and CFD flow studies in an intracranial aneurysm model with Newtonian and non-Newtonian fluids.

BACKGROUND: According to the clinical data, flow conditions play a major role in the genesis of intracranial aneurysms. The disorder of the flow structure is the cause of damage of the inner layer of the vessel wall, which leads to the development of cerebral aneurysms. Knowledge of the alteration of the flow field in the aneurysm region is important for treatment. OBJECTIVE: The aim is to study quantitatively the flow structure in an patient-specific aneurysm model of the internal carotid artery using both experimental and computational fluid dynamics (CFD) methods with Newtonian and non-Newtonian fluids. METHODS: A patient-specific geometry of aneurysm of the internal carotid artery was used. Patient data was segmented and smoothed to obtain geometrical model. An elastic true-to-scale silicone model was created with stereolithography. For initial investigation of the blood flow, the flow was visualized by adding particles into the silicone model. The precise flow velocity measurements were done using 1D Laser Doppler Anemometer with a spatial resolution of 50 µ m and a temporal resolution of 1 ms. The local velocity measurements were done at a distance of 4 mm to each other. A fluid with non-Newtonian properties was used in the experiment. The CFD simulations for unsteady-state problem were done using constructed hexahedral mesh for Newtonian and non-Newtonian fluids. RESULTS: Using 1D laser Doppler Anemometer the minimum velocity magnitude at the end of systole -0.01 m/s was obtained in the aneurysm dome while the maximum velocity 1 m/s was at the center of the outlet segment. On central cross section of the aneurysm the maximum velocity value is only 20% of the average inlet velocity. The average velocity on the cross-section is only 11% of the inlet axial velocity. Using the CFD simulation the wall shear stresses for Newtonian and non-Newtonian fluid at the end of systolic phase (t= 0.25 s) were computed. The wall shear stress varies from 3.52 mPa (minimum value) to 10.21 Pa (maximum value) for the Newtonian fluid. For the non-Newtonian fluid the wall shear stress minimum is 2.94 mPa; the maximum is 9.14 Pa. The lowest value of the wall shear stress for both fluids was obtained at the dome of the aneurysm while the highest wall shear stress was at the beginning of the outlet segment. The vortex in the aneurysm region is unstable during the cardiac cycle. The clockwise rotation of the streamlines at the inlet segment for Newtonian and non-Newtonian fluid is shown. CONCLUSION: The results of the present study are in agreement with the hemodynamics theory of aneurysm genesis. Low value of wall shear stress is observed at the aneurysm dome which can cause a rupture of an aneurysm.

Flow analyses of microvascular bifurcation using laser Doppler anemometry.

INTRODUCTION: Vascular surgery affects, among other factors, vessel geometry and might result in significant flow changes. For this reason a basic understanding of flow behavior at bifurcations plays an important role for microsurgeons. The aim of the present work was to establish an experimental model that enables rheological analyses of microvascular techniques. METHODS: Laser Doppler anemometer (LDA) measurements in a total of four cross-sections of a true-to-scale silicone model were performed. The model was installed in a circulatory experimental setup that simulates the physiologic human blood flow. The flow velocity data measured with the LDA system was processed and analyzed with an image-processing system. RESULTS: The flow curve at each cross-section was recorded for sevem cycles. A physiologic flow separation at bifurcational level was seen. Maximal and minimal horizontal velocities of all measurement points were between 0.32 and -0.15 m/s. No signs of turbulentlike flow were seen in the cross-sections distal to the bifurcation. A total, centrally located backflow in the diastolic phases in all four cross-sections was registered, resembling an oscillatorylike flow. CONCLUSIONS: The LDA analysis represents a valid experimental method for rheological evaluation of microvessels. Due to its unique high spatial and temporal resolution, it represents a worthwhile alternative to other flow investigations.

[Novel uses of afterbirth tissues in regenerative medicine]. / Neue Verwendungsmöglichkeiten von Nachgeburtsgewebe für die Regenerative Medizin.

INTRODUCTION: Afterbirth tissues, which include the umbilical cord, placenta, amnion, and cord blood, are usually discarded. Recent progress in regenerative medicine suggests that we re-evaluate these tissues and assess their therapeutic potential. METHODS: Firstly the unique properties of afterbirth tissues and their current use in regenerative medicine are summarised. Then we introduce the cooperation of our institutions and our experiences regarding the collection and utilisation of afterbirth tissues. RESULTS: A literature survey suggests that besides the well-known transplantation of hematopoietic stem cells from cord blood, afterbirth tissues were also used as a source of stem cells, progenitor cells, differentiated cells, and blood vessels for tissue engineering purposes. According to our own experience, the two participating OB/GYN departments and the blood donation service were able to organise a sufficient supply of umbilical cords for research purposes. The yield correlated with incentives for the midwives. A total of more than 4,300 cords was collected for experiments designed to create small caliber vessel grafts. The contamination rate was low. Birth mode significantly affected umbilical vein function, whereas ischaemia for up to 40 h did not have any deleterious effects. Umbilical veins were cryopreserved with a moderate loss of function. Fresh umbilical veins were endothelium-denuded and reseeded with endothelial cells harvested from coronary artery disease patients to generate an autologous surface. CONCLUSIONS: Afterbirth tissues have unique properties which make them ideally suited for regenerative medicine. These tissues can be procured and utilised in research facilities even in the absence of an in-house birthing centre.

Do contrast agents affect ultrasound flow measurements?

The use of iodine contrast agents during angiography can put patients at risk. The replacement of angiography through duplex ultrasound methods would, therefore, be of great interest. Even when duplex sonography is used however, an x-ray angiography is often performed afterwards to verify the diagnosis. This causes complications in an unacceptable number of patients. The safety of duplex ultrasound sonography diagnosis can be improved by using low-risk Doppler contrast agents. Slow blood flow through vessels with a high degree stenosis and intracerebral flow can be more easily and accurately detected using these agents. However, amplification of the Doppler echo alters the measurements during both high and low flow, so that the flow rate cannot be recorded very precisely. Our goal was to study the effect of a contrast agent on velocity measurements with color-coded Doppler ultrasonography and on pulsed, one-goal measurements. We used a laser-Doppler-anemometer (LDA) with high temporal and spatial resolution as a reference method to compare the measurements.

On using experimentally estimated wall shear stresses to validate numerically predicted results.

The objective of this investigation was to assess the use of experimentally estimated wall shear stresses to validate numerically predicted results. The most commonly cited haemodynamic factor implicated in the disease initiation and proliferation processes at graft/artery junctions is wall shear stress (WSS). WSS can be determined from the product of the viscosity of the fluid and the wall shear rate. Numerically, the wall shear rate is predicted using velocity values stored in the computational cell near the wall and assuming zero velocity at the wall. Experimentally, the wall shear rate is estimated by applying a curve-fit to near-wall velocity measurements and evaluating the shear rate at a specific distance from the wall. When estimating the wall shear rate from the laser Doppler anemometry (LDA) point velocity measurements, large differences between the experimentally estimated and numerically predicted WSSs were introduced. It was found that the estimated WSS distributions from the experimental results are highly dependent on the curve-fitting method used to calculate the wall shear rate. However, the velocity profiles for both the experimental and numerical investigations show extremely good comparison. It is concluded that numerical models should be validated using unprocessed LDA point velocity measurement and not estimated WSS values.

Fluidodynamic evaluation of arteriovenous fistulae for hemodialysis.

Arteriovenous fistulae (AVF) are commonly used in dialysis treatment of uremic patients. However, many AVF create problems and have to be re-examined. Problems arise in the cannulation site and must be treated with antibiotics, and stenosis, both in the arterial and in the venous side of the AVF. In the worst case, the AVF must be replaced for treatment to continue. However, this can only be repeated once before the AVF site is no longer viable. This increases the discomfort, the morbidity and the mortality of the dialysis patient. Several kinds of AVF were studied to determine whether flow disturbances give rise to these complications. Many studies have already demonstrated the importance of hemodynamic factors in vascular disease pathogenesis. These factors include: the pulsatility of flow, the elasticity of the vessel, the non-Newtonian blood, flow behavior and, very importantly for AVF, the vessel geometry. In model studies, intimal changes have been observed in bends and bifurcations, regions of vessel construction and vessel stenosis. In these regions, blood flow changes abruptly and this contributes to arterial disease. We prepared several one-to-one, true-to-scale elastic silicon rubber models of different AVF. The AVF models were based on angiographic studies of chronic dialysis patients and on AVF from the arms of cadavers. The models had a similar compliance to that of the human blood vessel. Flow was visualized using photoelasticity apparatus and a birefringent blood-like fluid. This method is suitable to analyze the spatial configuration of flow profiles, to differentiate laminar flow from disturbed flow, and to visualize flow separation, vortex formation and secondary flow. It was found that AVF create disturbances that are not found under normal physiological flow conditions. The X-formed AVF was very unsatisfactory, creating significant flow disturbances. The AVF had high velocity fluctuations. These could lead, for example, to aneurysm formation. A better configuration would be an end-to-end AVF. However, this formation creates other complications. For example, there is not enough blood to the hand and parts of the hand lose feeling. The recommended AVF would be an end-to-side anastomosis. In this case, attention is needed for placement geometry, to minimize additional flow disturbances. Several models as well as patient angiographic studies are discussed.

Localization of bypass-induced changes in flow in coronary artery models.

Right coronary artery bypass restores blood flow through heart tissues. This also induces changes in flow leading to its failure. By this work the sites which are prone to such changes are localized. The bypass models are developed from transparent silicon rubber of elastic properties similar to arterial tissues. Flow visualization is carried out by photoelasticity technique by using dilute solution of vanadium pentoxide. This analysis carried out under pulsatile flow conditions shows that the proximal stenotic region continues to contribute to the alteration in flow in the hood region of the bypass. Thus making its proximal and distal regions prone to flow-induced changes, which may lead to its blockage over the long duration.

The discrimination of stenosed carotid bifurcation models with smooth and irregular plaque surface. Part I. Laser and ultrasonic Doppler flow studies.

Irregular carotid lesion surface is considered as a factor increasing the risk of the cerebral embolism. The objective of the study was to investigate the possibility to distinguish models of stenosed carotid bifurcation with lesion irregularity on the basis of the properties of flow velocity distributions. Two groups of elastic replicas of carotid bifurcations with different stenosis degree were investigated. Each group consisted of three models with different severity of plaque surface irregularity and one with smooth wall. Velocity data were collected using a one-component laser Doppler anemometer (LDA) system and a pulsed Doppler flowmeter. The LDA velocity distributions and Doppler spectral broadening index, turbulence intensity index and coefficient of skewness were analysed. The lesion irregularity resulted in change of the size and/or shape of reversed/reduced flow areas and of the position of the jet with respect to those observed in a smooth wall model. The flow features observed in the ultrasonic Doppler spectra were generally coherent with the axial LDA velocity distributions. Doppler spectral parameters demonstrated different sensitivities to the severity of the wall irregularity, however, the complexity of curves of these indices versus time did not allow to draw decisive conclusions and implied use of a more sensitive tool of analysis.

The discrimination of stenosed carotid bifurcation models with smooth and irregular plaque surface. Part II. The multivariate statistical analysis of ultrasonic Doppler velocity data.

According to the conclusion of the first part of the paper the Doppler spectral indices were analyzed in a detailed manner to provide a means to differentiate bifurcation models with different irregularities. Autoregressive (AR) models using the Akaike FPE criterion were fitted to the curves of the spectral broadening index, turbulence intensity index and coefficient of symmetry. These curves were also submitted to the data reduction significant point extraction algorithm. The multivariate discriminant analysis was performed on parameter vectors containing coefficients of AR models, data reduction rate and data reduction error. The discriminant analysis allowed distinguishing models with the same degree of stenosis and different plaque surface characteristics on the basis of these vectors. The highest discrimination efficiency was observed for parameter vectors obtained from TBI and SKEW curves. The efficiency of discrimination was slightly higher for more severely stenosed models.

Laser-Doppler-anemometry studies of flow behavior in rigid and elastic varicose vein models.

Flow behavior and velocity were studied in six varicose vein models with simulated arteriovenous anastomoses (AVAs). Experiments were performed to determine whether incoming flow entering from AV-anastomoses or small feeder veins could create either small jet streams or velocity fluctuation, which might then cause veins to bulge and get tortuous. Flow was analyzed in areas of flow change. Studies were performed in rigid Plexiglas and elastic, silicon rubber models that exactly replicated the geometry and compliance of varicose veins. Flow was visualized with dyes for steady flow and with a birefringent solution for pulsatile flow studies. Local velocity was measured with a laser-Doppler-anemometer (LDA). Very low forces and shear stresses were found on the interior wall opposite the entrance of the simulated AV anastomoses. However, these values were ten times that of an idealized flow in a straight tube without added flow from simulated AV anastomoses.

Hemodynamics in the carotid artery bifurcation: a comparison between numerical simulations and in vitro MRI measurements.

The presence of atherosclerotic plaques has been shown to be closely related to the vessel geometry. Studies on postmortem human arteries and on the experimental animal show positive correlation between the presence of plaque thickness and low shear stress, departure of unidirectional flow and regions of flow separation and recirculation. Numerical simulations of arterial blood flow and direct blood flow velocity measurements by magnetic resonance imaging (MRI) are two approaches for the assessment of arterial blood flow patterns. In order to verify that both approaches give equivalent results magnetic resonance velocity data measured in a compliant anatomical carotid bifurcation model were compared to the results of numerical simulations performed for a corresponding computational vessel model. Cross sectional axial velocity profiles were calculated and measured for the midsinus and endsinus internal carotid artery. At both locations a skewed velocity profile with slow velocities at the outer vessel wall, medium velocities at the side walls and high velocities at the flow divider (inner) wall were observed. Qualitative comparison of the axial velocity patterns revealed no significant differences between simulations and in vitro measurements. Even quantitative differences such as for axial peak flow velocities were less than 10%. Secondary flow patterns revealed some minor differences concerning the form of the vortices but maximum circumferential velocities were in the same range for both methods.

[Optimal expansion of the multi-link stent. An in vitro study with high resolution roentgen technique]. / Optimierte Expansion des Multi-Link-Stents. Eine In-vitro-Untersuchung mittels hochauflösender Röntgentechnik.

It has been speculated that high pressure implantation may improve the results of coronary stenting. However, this method bears the risk of persistent dissection and may increase late lumen loss. Presently, there is no consensus about the optimal stent implantation technique with the regard to balloon size and pressure. To elucidate this question an experimental study was performed in a coronary stenosis model. 3.5 mm Multi-Link (ML) stents were implanted in 3.3 mm silicone rubber tubes containing 50% concentric narrowings. Three implantation techniques were applied: 1. The standard technique using the conventional ML delivery system with a compliant balloon (ML-ST). 2. A new deployment method with a high pressure delivery system (ML-HP). 3. "Focal postdilation" using the ARC catheter, which has a special balloon with an inner compliant and an outer non-compliant section (ML-ARC). For comparison, the Palmaz-Schatz stent was implanted by using a high pressure balloon. Stent expansion was imaged by magnification radiography. Minimal lumen diameter within the stent (MLD) and the lumen diameter outside the stent (BD) were measured after dilations with 6, 9, 12, 15, 18, and 21 atm. The relation of the BD to the MLD was used as an index of vessel trauma. The results lead to the following conclusions: 1. A complete apposition to the vessel wall for a balloon/vessel relation of 1.1:1 could not be reached with pressures below 9-15 atm. The increase of the pressure beyond 15 atm resulted only in a minimal additional lumen. 2. Compared to the Palmaz-Schatz stent the recoil of the ML stent was significantly lower. 3. For all three implantation techniques the ML-ARC showed the best results with the maximal dilation of the stenotic vessel-area and the minimal expansion of the vessel outside the stent.

Flow visualization and 1- and 3-D laser-Doppler-anemometer measurements in models of human carotid arteries.

Pulsatile flow, wall distensibility, non-Newtonian flow characteristics of blood in flow separation regions, and high/low blood pressure were studied in elastic silicon rubber models having a compliance similar to human vessels and the same surface structure as the biological intima models of (1) a healthy carotid artery model, (2) a 90% stenosis in the ICA, and (3) 80% stenosis in both the internal and external carotid arteries. Flow was visualized for steady flow and pulsatile studies to localize flow separation regions and reattachment points. Local velocity was measured with a 1-, 2-, or 3-D laser-Doppler-anemometer (LDA). Flow in the unstenosed model was Re = 250. In the stenosed models, the Re number decreased to Re = 180 and 213 under the same experimental conditions. High velocity fluctuations with vortices were found in the stenosed models. The jet flow in the stenosis increased up to 4 m/s. With an increasing bifurcation angle, the separation regions in the ECA and ICA increased. Increased flow (Re = 350) led to an increase in flow separation and high velocity shear gradients. The highest shear stresses were nearly 20 times higher than normal. The 90% stenosis created high velocity shear gradients and velocity fluctuations. Downstream of the stenoses, eddies were found over the whole cross-section. In the healthy model a slight flow separation region was observed in the ICA at the branching cross-section whereas in the stenosed models, the flow separation regions extended far into the ICA. We conclude that a detailed understanding of flow is necessary before vascular surgery is performed especially before artificial grafts or patches are implanted.

Biofluid mechanics.

The flow behavior of biological fluids in living organisms plays a crucial role in determining the state of the tissue through which they flow. Biofluid mechanics, the study of the fundamentals of biological fluid flow, has been recognized to be extremely important for the understanding of how changes in the flow behavior within living tissue maybe affect both the fluid and the tissue. Fluids in living tissue include blood, water, air and bodily fluids of animals, as well as the fluids in plants. The movement and balance of forces in resting fluids and fluids in motion are among the basic subjects for research. Biofluid mechanics is a field whose importance to the field of bioengineering has increased over the last two decades as pharmaceuticals, biomaterials and non-invasive diagnostic and surgical procedures create changes in the fluid mechanics of biofluids. Biofluid mechanics is a complex field including one of the most important areas of study--blood flow and cardiovascular diseases.

Analysis of ultrasonic Doppler velocity data obtained in models of stenosed carotid bifurcations with irregular lesion surface.

In this study properties are concerned of ultrasonic Doppler spectra recorded distal to an irregularity localised in the internal carotid artery of a true-to-scale elastic model of a severely stenosed carotid bifurcation. Four models differing in irregularity were obtained by melting graded holes in the original wax cast, about 5-7 mm distal to the bifurcation. Velocity data were collected using an HP Sonos 2500 ultrasonograph working in pulsed Doppler mode. The observed effect of the irregularity with respect to the smooth wall model consisted in: (1) presence of a reduced flow zone 15 mm distal to the severe irregularity situated at the outer wall of the model in the ICA branch; (2) presence of a recirculation zone 15 mm distal to the severe irregularity situated at the inner wall of this model; (3) negative values of the measure of symmetry of the Doppler spectrum and (4) decreased values of relative width of Doppler spectra obtained 25 mm distal to the bifurcation in models with severe irregularity. The alterations of flow distribution and Doppler spectra depend on the geometry of the model under investigation and this study provides an indication as to what phenomena can happen in a model of stenosed carotid bifurcation with irregular lesion surface and how these phenomena may affect the ultrasonic Doppler spectra. Such information could be used in the evaluation of the risk of cerebral embolism.