一种可以避免血管再狭窄的双移植管搭桥方式的数值模拟

目的为改善冠状动脉旁路移植管的局部血流动力学,降低血管再狭窄的发生机率,研究一种可以避免血管再狭窄的双移植管搭桥方式。方法利用有限元分析方法,对传统模型和双移植管搭桥模型进行血流动力学模拟仿真,计算缝合区附近的流场、壁面切应力等血流动力学因素的分布情况。结果该双移植管搭桥具有较好的血流动力学分布,明显改善了主搭桥血管与冠状动脉缝合处的血流动力学参数,消除了该部位的涡流和流动停滞点,提高了底面的壁面切应力数值。在辅助搭桥血管与冠状动脉缝合处涡流区长度仅3 mm,与原主搭桥血管缝合处的涡流长度4.5 mm相比明显减小。辅助搭桥管分流了约36%的血液,只有约64%的血液流过了主搭桥管。结论该双移植管搭桥有助于减小内膜增生的发生机率。     

具有不同移植管-宿主动脉直径比的冠状动脉搭桥术的血流动力学仿真比较

为了说明移植管-宿主动脉直径比对冠状动脉搭桥术的流场及壁面切应力的影响，构造了三个具有不同移植管-宿主动脉直径比的冠状动脉搭桥术模型，三个模型的移植管直径分别小于、等于和大于宿主动脉的直径；利用有限单元数值模拟方法对三个模型中的生理性脉动血流进行了仿真分析；对流场、壁面切应力及其相关系数的时空分布进行了显示和比较。结果表明，大直径比的模型具有相对较大的纵向速度、大而均匀的壁面切应力以及小的壁面切应力梯度，从而在一定程度上改善了血流动力学；在搭桥术应用中采用大于或等于1的直径比是可取的。然而，在三个模型中，与壁面切应力相关的时间参数并没有显著差别。为了提高冠状动脉搭桥术的畅通率，设计新的缝合结构是很有必要的。     

股动脉双路搭桥的血流动力学仿真

在传统股动脉搭桥术中，由于下游缝合区采用“端对侧”的“单路搭桥”缝合方式，移植管中血流会对缝合区底面产生很大冲击，引起局部血流动力学急剧变化，并可能因此而导致血管再狭窄和手术失败。由于缝合区几何结构的不对称必然导致流场的不均匀，本研究提出了“对称双路搭桥”的构想以图改善血流动力学。本研究对“单路”和“对称双路”两种连接模型中的血液流动进行了数值模拟。两种模型利用相同的几何参数进行建模，并采用了相同的边界条件。数值模拟结果包括流场、壁面切应力及其梯度等血流动力学参数。研究表明，“对称双路”模型比“单路”模型具有较大的纵向速度、较小的二次流、较均匀的壁面切应力等。因此，“对称双路”搭桥模型具有更好的血流动力学，可以减少股动脉搭桥术后内膜增生和再狭窄的可能性。     

双路搭桥术的移植管直径对血液流动的影响

移植管直径对搭桥术的长期通畅率具有至关重要的作用.为了弄清楚移植管直径对双路搭桥术中血液流动的具体影响,利用数值仿真的方法对两个股动脉双路搭桥模型中的生理脉动流进行了研究.为便于比较,除移植管直径不同以外,两个模型均采用相同的几何参数来建模.我们将研究直径一小和一大两个模型.两个模型的流动仿真边界条件相同.峰值雷诺数为832.8,Wcmersley数为6.14.重点分析了下游缝合区流场.对速度场、上下游足尖的压力差、壁面切应力及其梯度、应力波动系数等血流动力学参数的时空分布进行了比较.研究表明,大直径移植管模型下游缝合区的纵向速度和二次流速度较为紊乱,而其足尖下游远端的轴向流动则具有较大而均匀的纵向速度.同时,大移植管模型具有较小的回流、较均匀的壁面切应力、较低的压力、较小的壁面切应力梯度等特点.然而在二次流分布和应力波动系数方面却没有优势.总之,大移植管模型在近壁部分具有更好、更均匀的血流动力学现象,可以有效地避免术后内膜增生和再狭窄的发生和发展.     

S形动脉中的血流动力学研究

目的 探索动脉直径大小对S 形动脉血流动力学的影响。方法 利用数值模拟方法, 对具有不同直径的大小两种S 形动脉模型在相同的边界条件下的血流动力学时空分布进行了分析。结果 在大S形动脉中的二次流比小S形动脉中的要复杂; 在弯曲动脉的内弯区存在较强的涡流; 弯曲动脉中的压力和壁面切应力变化很剧烈, 特别是在大模型中。结论 S形弯曲动脉中的血流呈现复杂回流、二次流、压力和壁面切应力剧烈变化等特性, 这些都可能影响到动脉内皮的功能及内膜增生。在利用人造或自体血管修复旁路狭窄动脉的手术中, 应尽量避免采用S 形动脉模型。     

冠状动脉移植管的血流动力学数值模拟

采用有限元数值计算的方法，模拟了冠状动脉搭桥术中移植管内的生理流动。计算模型包括了冠状动脉狭窄，并考虑了由于移植管直径大于冠状动脉直径而在两者缝合时移植管的变形。计算结果分析了缝合区附近的流场、二次流、壁面切应力在心动周期内的时空分布情况。计算结果表明，在缝合前端下游，存在一个低切应力、高切应力梯度的区域，在缝合区底部存在一个高切应力、高切应力梯度的区域。这两个区域都是内皮细胞增生并造成移植管术后再阻塞的危险部位。     

颈动脉血管壁切应力的分析

动脉中管壁的脉动低切应力在动脉粥样硬化形成中起始动和主要的决定作用.本文比较了几种计算血管壁切应力的方法,认为采用有约束的弹性管模型计算获得的动脉壁切应力更适合于临床应用.根据检测得到的正常人和动脉硬化性脑血管病患者的颈动脉血流速度、血管管径等数据,计算两者的颈动脉壁面切应力.研究发现动脉硬化性脑血管病患者的壁面切应力比正常人显著减小.这表明,颈动脉的壁面切应力可以作为动脉硬化性脑血管疾病的早期诊断的重要参考指标.     

锁骨下动脉、颈总动脉和椎动脉分叉处血流动力学数值模拟

目的:探讨锁骨下动脉、颈总动脉和椎动脉分叉处的血流动力学特性,分析该处发生血管狭窄引起大脑供血不足的 血流动力学原因。方法:采用内蒙古民族大学附属医院神经内科提供的CT数据,应用医学建模软件MIMICS20.0将患者 二维CT数据进行三维血管重建,经过网格划分及边界条件设置后导入计算流体力学软件FLUENT14.5中。计算和分析 不同血液入口速度的锁骨下动脉、颈总动脉和椎动脉分叉处的血流动力学特性。结果:在血液入口速度不同的情况下,锁 骨下动脉、颈总动脉和椎动脉分叉处的血液流场分布、血液压力分布和血管壁面切应力分布有显著变化。在血液入口速 度增大时,锁骨下动脉分叉处和颈总动脉分叉处的血液流速快、血管壁压力大,颈总动脉内侧血管壁面切应力大,但锁骨 下动脉分叉处和颈总动脉分叉处血管壁面切应力数值和变化幅度小,属于低切应力区。结论:通过血流动力学数值模拟 研究,分析锁骨下动脉、颈总动脉和椎动脉分叉处易发生粥样斑块病变导致大脑供血不足的血流动力学原因。     

支架置入椎动脉开口处狭窄后突出距离的血流动力学分析

目的探讨支架置入椎动脉开口处狭窄后突出到左锁骨下动脉的距离对局部血流动力学的影响。方法分别构建未置入支架(模型1)以及置入支架无下移(模型2)、下移1 mm(模型3)、2 mm(模型4)、3 mm(模型5)的椎动脉模型。利用计算流体力学方法进行数值模拟,比较不同模型的血流流速、壁面切应力等血流动力学差异。结果支架置入术后,模型2的支架段壁面切应力降低85.33%、血流速度降低35.36%、旋动流现象消失。支架下移不同程度的几个模型相比,狭窄段的壁面切应力相差最大0.76%、血流速度相差最大0.45%。结论支架的置入椎动脉开口狭窄后的血流动力学变化显著,而支架下移距离对椎动脉流速和壁面切应力的影响不明显。     

单路和双路CABG中血流动力学的比较

为了改善冠状动脉搭桥术后的血流动力学，提出了对称双路搭桥的改进措施。利用有限元分析方法，对冠状动脉搭桥术中单路移植管和对称双路移植管内的生理流动进行了数值模拟，并对两种情况下的血流动力学计算结果进行了比较。计算结果分析了缝合区附近的流场、壁面剪应力等血流动力学因素在心动周期内的时空分布情况。研究结果表明，对称双路搭桥比单路搭桥具有更合理的血流动力学，可以避免动脉粥样硬化的危险性血流动力学因素，从而减少手术再狭窄的发生。     

Influence of graft-host diameter ratio on the hemodynamics of CABG

The graft-host diameter ratios have impacts on the flow patterns of bypass graft. In order to clarify the influence of graft-host diameter ratios on the flow patterns and the wall shear stress in coronary artery bypass graft (CABG), the pulsatile blood flows in three CABG models, with the graft diameter larger than, equal to and smaller than that of the coronary artery, were simulated with finite element method. The temporal-spatial distributions of flow patterns, wall shear stresses (WSS), wall shear stress gradients (WSSG), oscillating shear index and shear stress ratio were depicted and compared. Of the three models evaluated, large model can bring about better hemodynamics to some extent with relatively large positive longitudinal velocity, uniform and large WSS, and small WSSG. The results suggest that larger or isodiametric graft is favorable. However, no distinct difference of WSS based temporal parameters was found between all the three models. Alternative anastomotic designs are necessary for the improvement of CABG patency rates.     

冠状动脉搭桥术中移植管-宿主动脉直径比和缝合角的优化与分析

目的探索怎样的移植管-宿主动脉直径比和缝合角可以最大限度地提高冠状动脉搭桥术的成功率。方法借助ANSYS9.0对冠状动脉搭桥术进行模拟仿真,用响应面方法建立数学模型,利用优化理论寻找最优的移植管-宿主动脉直径比和缝合角,使影响手术成功率的主要因素-壁面切应力梯度最小。结果结果表明冠状动脉搭桥术中,大移植管-宿主动脉直径比和小缝合角的模型具有更好的血流动力特性。结论影响冠状动脉搭桥术成功率的因素很多,在现有条件下借助临床经验指导,选择尽可能大的移植管-宿主动脉直径比和尽可能小的缝合角的做法是可取的。     

A numerical study of blood flow in coronary artery bypass graft side-to-side anastomoses

Purpose: When sequential grafts are used in multivessel coronary artery bypass grafting, the graft first supplies blood to one or more coronary arteries via a side-to-side anastomosis. We studied hemodynamics in idealized models of parallel and diamond side-to-side anastomoses, identifying features that might promote restenosis. Methods: Blood flow was computed in three representative anastomosis configurations: parallel side-to-side, diamond side-to-side, and end-to-side. We compared configurations and the effect of host-graft diameter ratio. Results:Hemodynamic patterns depended strongly on anastomosis geometry and graft/host diameter ratio. In the distal graft, the diamond configuration had large areas of low wall shear stress (WSS) and high spatial WSS gradients. In the proximal graft the unfavorable WSS patterns were comparable for all models, while the distal portion of the host artery the diamond model was best. Models with smaller host arteries had smaller regions of low WSS. Conclusions: The parallel configuration was preferred over the diamond for maintaining graft patency, while the diamond configuration appeared best for maintaining host artery patency. Since graft patency is critical, parallel configurations seem hemodynamically advantageous. Larger graft/host ratios have better hemodynamic performance than smaller ones. © 2002 Biomedical Engineering Society. PAC2002: 8719Uv, 8710+e     

Wall shear stresses in small and large two-way bypass grafts

Wall shear stress, as one of the most important hemodynamic parameters of the cardiovascular system, has been studied extensively in the numerical and experimental approaches to blood flow in various arteries. In order to clarify the influence of graft diameter on the wall shear stress in a femoral two-way bypass graft, the pulsatile blood flows in two models were simulated with the finite element method. Both models were constructed with different diameters of grafts. The main geometric structure and the boundary conditions were identical for both models. The emphasis was on the comparison analysis of wall shear stresses in the vicinity of the distal anastomosis. The temporal-spatial distributions of wall shear stresses, wall shear stress gradients, and oscillating shear index were analyzed and compared. The present study indicated that femoral artery bypassed with a large graft demonstrated relatively uniform wall shear stresses and small wall shear stress gradients, whereas it does not have advantages in the oscillating shear index. The large model exhibits better and more regular hemodynamic phenomena and may be effective in decreasing the probability of the initiation and development of postoperative intimal hyperplasia and restenosis. Thus, appropriately large grafts are applicable in the clinical practice of femoral two-way bypass operation. More detailed studies are necessary on this problem for the purpose of increasing the success rates of the femoral bypass grafts.     

Influences of graft diameter on the blood flow in 2-way bypassing surgery

The graft diameter plays a critically important role in the long-term patency rates of bypass surgery. To clarify the influence of graft diameter on the blood flows in the femoral 2-way bypass surgery, the physiologically pulsatile flows in two femoral bypass models were simulated with numerical methods. For the sake of comparison, the models were constructed with identical geometry parameters except the different diameters of grafts. Two models with small and large grafts were studied. The boundary conditions for the simulation of blood flow were constant for both models. The maximum Reynolds number was 832.8, and the Womersley number was 6.14. The emphases of results were on the analysis of flow fields in the vicinity of the distal anastomosis. The temporal-spatial distributions of velocity vectors, pressure drop between the proximal and distal toe, wall shear stresses, wall shear stress gradients and oscillating shear index were compared. The present study indicated that femoral artery bypassed with a large graft demonstrated disturbed axial flow and secondary flow at the distal anastomosis while the axial flow at its downstream of toe was featured with larger and more uniform longitudinal velocities. Meanwhile, the large model exhibits less refluences, relatively uniform wall shear stresses, lower pressure and smaller wall shear stress gradients, whereas it does not have any advantages in the distributions of secondary flow and the oscillating shear index. In general, the large model exhibits better and more uniform hemodynamic phenomena near the vessel wall and may be effective in preventing the initiation and development of postoperative intimal hyperplasia and restenosis.     

Computational Investigation of Hemodynamics in Fully Stenosed CABG

Coronary Artery Bypass Graft (CABG) is an important surgical treatment for critically stenosed arteries. Unfortunately restenosis always occurs after CABG surgery, which bring about surgery failure, lntimal thickening in the CABG distal anastomosis has been implicated as the major cause of restenosis and long-term graft failure. The nonuniform hemodynamics including disturbed flows, recirculation zones, oscillating wall shear stress, and long particle residence time were thought to be the possible etiologies. Numerical simulation was proved to be of great help and guidance meaning for the biofluid mechanics research and the CABG surgical plan. The present study was based on the hypothesis that the geometry configuration of CABG could greatly influence the hemodynamics in the vicinity of anastomosis. The hemodynamic features of two geometry models of end-to-side CABG were studied and compared. One simulated a conventional CABG with 1-way bypass graft, and the other simulated a modified CABG with symmetric 2-way bypass graft. The numerical investigations of hemodynamics in these two models with fully stenosed coronary arteries were accomplished using finite element method. The temporal and spatial distributions of hemodynamics were analyzed and compared. Results showed that the presence of symmetric 2-way bypass graft was of reasonable and favorable hemodynamics than 1-way bypass graft. The modified CABG model created a more hemodynamically efficient streamlined environment with higher mean and maximum axial velocities and lower radial velocities than the conventional 1-way model. Meanwhile, the symmetric 2-way bypass graft was featured with low pressure near the wall, high and uniform WSS in the host artery. All of these were favorable for inhibiting the development of intimal thickening, restenosis, and ultimate failure of the CABG, and it could considerably improve the flow conditions and decrease the probability of intimal hyperplasia and restenosis of CABG.     

The hemodynamic effects of compliance, bulging, and curvature in a saphenous vein coronary artery bypass graft model.

The development of Intimal Hyperplasia (IH) in saphenous vein coronary artery bypass grafts (SV-CABG) is responsible for the short-term patency of these grafts. Previous studies of SV-CABG models were performed on rigid anastomotic vessels. However, the effects of compliance, bulging and curvature at the anastomosis on the general hemodynamic field, due to compliance and geometric mismatch between the vein and the artery have not been evaluated. We studied axial and transverse velocities by Laser Doppler Velocimetry on a compliant, in vitro, anatomical model of an end-to-side saphenous vein graft (SVG) to left anterior descending (LAD). The model incorporated a bulge at the sinus and curvature at the graft-host junction. Physiologic pressure and flow conditions pertaining to SV-CABG were applied. The presence of the bulge and curvature showed differences in the velocity profiles in comparison with previous rigid model studies. Dynamic separation zones were temporally augmented at the flow divider. The moving stagnation point at the floor of the host vessel was observed to move past the toe of the model during the accelerating portion of the cycle. These findings suggest that the presence of the bulge curvature and compliance may further favor conditions for the development of intimal hyperplasia (IH) at the floor of a CABG.     

In vitro measurements of velocity and wall shear stress in a novel sequential anastomotic graft design model under pulsatile flow conditions

This study documents the superior hemodynamics of a novel coupled sequential anastomoses (SQA) graft design in comparison with the routine conventional end-to-side (ETS) anastomoses in coronary artery bypass grafts (CABG). The flow fields inside three polydimethylsiloxane (PDMS) models of coronary artery bypass grafts, including the coupled SQA graft design, a conventional ETS anastomosis, and a parallel side-to-side (STS) anastomosis, are investigated under pulsatile flow conditions using particle image velocimetry (PIV). The velocity field and distributions of wall shear stress (WSS) in the models are studied and compared with each other. The measurement results and WSS distributions, computed from the near wall velocity gradients reveal that the novel coupled SQA design provides: (i) a uniform and smooth flow at its ETS anastomosis, without any stagnation point on the artery bed and vortex formation in the heel region of the ETS anastomosis within the coronary artery; (ii) more favorable WSS distribution; and (iii) a spare route for the blood flow to the coronary artery, to avoid re-operation in case of re-stenosis in either of the anastomoses. This in vitro investigation complements the previous computational studies of blood flow in this coupled SQA design, and is another necessary step taken toward the clinical application of this novel design. At this point and prior to the clinical adoption of this novel design, in vivo animal trials are warranted, in order to investigate the biological effects and overall performance of this anastomotic configuration in vivo.     

动脉血流旋动原理在人造血管研制和血管移植术中的应用

目的 将血液流动的旋动流原理用于心血管介入治疗,以期解决小口径人造血管的急性血栓堵塞问题和搭桥手术后下游处血管内膜增生引起的血管再狭窄问题。方法 使用计算流体力学（CFD）分别研究具有旋动流特性的新型小口径、S型搭桥和偏心搭桥模型中的流场以及壁面剪切力的分布。同时研究在旋动流下血小板的黏附情况和不同角度的S型搭桥下的血管内膜增生。结果 旋动流能明显提高壁面剪切力,抑制血小板的黏附以及血管内膜增生。结论 在心血管介入治疗和器械设计中引入旋动流确实可明显改善这些器械中的血流流场,达到抑制小口径人造血管的急性血栓形成和搭桥手术后血管内膜增生的目的。