A.E. Giannakopoulos

Dynamic behavior of suture-anastomosed arteries and implications to vascular surgery operations

BackgroundRoutine vascular surgery operations involve stitching of disconnected human arteries with themselves or with artificial grafts (arterial anastomosis). This study aims to extend current knowledge and provide better-substantiated understanding of the mechanics of end-to-end anastomosis through the development of an analytical model governing the dynamic behavior of the anastomotic region of two initially separated arteries.MethodsThe formulation accounts for the arterial axial-circumferential deformation coupling and suture-artery interaction. The proposed model captures the effects of the most important parameters, including the geometric and mechanical properties of artery and sutures, number of sutures, loading characteristics, longitudinal residual stresses, and suture pre-tensioning.ResultsClosed-form expressions are derived for the system response in terms of arterial radial displacement, anastomotic gap, suture tensile force, and embedding stress due to suture-artery contact interaction. Explicit objective functionalities are established to prevent failure at the anastomotic interface.ConclusionsThe mathematical formulation reveals useful interrelations among the problem parameters, thus making the proposed model a valuable tool for the optimal selection of materials and improved functionality of the sutures. By virtue of their generality and directness of application, the findings of this study can ultimately form the basis for the development of vascular anastomosis guidelines pertaining to the prevention of post-surgery implications.

Clinical relevance and treatment of carotid stent fractures

OBJECTIVE To review all published reports and investigate the clinical relevance and need for treatment of carotid stent fractures. METHODS Electronic and hand-searching of the published literature and the Manufacturer and User Facility Device Experience (MAUDE) database. RESULTS Thirteen articles were published. There are 10 case reports and 3 clinical studies. There are 26 reports of fractured stents in the MAUDE database. Fifty-five cases of carotid stent fractures are reported in total. A total of 201 carotid stents were examined in the 3 studies, and the incidence of fractures was 8.9% (18/201). Fractured stents were 22 Xact, 20 Acculink, 6 Precise, 2 Exponent, 1 Nexstent, 1 Genesis, 1 Symbiot, and 2 nonspecified nitinol self-expandable stents. Twenty-seven of the treated carotid lesions were atherosclerotic, 3 restenoses after carotid endarterectomy, 2 postradiational, 1 pseudoaneurysm, and 22 lesions of unknown pathology. Calcification was reported in 15 of the 27 atherosclerotic lesions (55.5%). Time from implantation to fracture ranged from 0 days (fracture during implantation) to 37 months. In 55% of the cases, stent fracture was associated with restenosis. Six patients presented with symptoms. Treatment was reported for 32 patients: 14 patients underwent de novo stent placement, 2 balloon angioplasty, 2 carotid endarterectomy, 2 bypass graft (1 vein, 1 polytetrafluoroethylene), 1 anticoagulation, and 11 patients were followed up. CONCLUSION Carotid stent fractures are mainly reported in self-expandable nitinol stents. Plaque calcification may be a risk factor for stent fractures. No difference was observed between open and closed-cell design. Stent fractures were often associated with restenosis and usually were asymptomatic. The actual incidence, clinical relevance, and optimal treatment remain to be clarified from larger prospective studies designed to investigate the issue.

Development of Strong Surfaces Using Functionally Graded Composites Inspired by Natural Teeth—A Theoretical Approach

In recent years functionally-graded composites have been proposed to develop strong surfaces that can withstand high contact and frictional forces. The present work presents a new graded composite that can be used for the development of surfaces with excellent strength properties. The composite is inspired by the human teeth, which nature builds as a hard and tough functionally-graded composite. The outer surface of teeth is of enamel, composed of prismatic hydroxyapatite crystallites, whereas the inner part of teeth is of dentine, composed collagen fibrils and hydroxyapatite. Enamel is hard, brittle, and wear resistant, while dentine is softer and flexible. The dentine-enamel junction is formed as a region at which enamel mixes with dentine in a continuous way. The nanomechanical properties of the transition zone have been recently revealed. Of particular interest in this investigation is the variation in the elastic modulus from the pure enamel to the pure dentine material, which leads to biomimetic graded composites that exhibit high surface strength. This work presents analytical solutions for the stress and displacement fields on an actual composite substrate, which is loaded by a line load. The elastic modulus of the substrate follows approximately the theoretical distribution.

Gradient Elastodamage Model for Quasi-Brittle Materials with an Evolving Internal Length

AbstractThe article presents a new approach based on a strain gradient damage constitutive law for modeling quasi-brittle materials such as concrete. The authors use a weak type nonlocal formulation of the problem, relying on Mindlin’s Form II strain gradient elasticity theory. Gibbs free energy is used and the influence of the positive and negative principal strains to damage evolution is separated. Additional energy dissipation due to the gradient of the positive principal strains is introduced. The model requires an internal length, which is treated as an internal variable dependent on the level of damage. The study shows that the internal length increases with damage, corroborating available experimental results. Calibration of the gradient internal length evolution with damage is established through experimental data from two independent tests: a uniaxial tension or compression test to establish the evolution of damage, and a four-point bending (loading-unloading) test to relate the variation of the ...

Pretwisted Beams in Axial Tension and Torsion: Analogy with Dipolar Gradient Elasticity and Applications to Textile Materials

AbstractA technical theory for pretwisted beams that accounts for variable twist (constrained warping) is based on an approximate displacement field that is defined completely in terms of two unknown functions: the axial displacement w1(z) and the rotation ϕ(z) of the cross section about the centroidal axis of the beam, z being the coordinate along the axis of the beam. The primary unknowns are determined by minimizing the potential energy of the beam. The problem is then formulated in terms of w1(z), and an analogue between the technical theory and a one-dimensional dipolar gradient elasticity model is presented. The application of the theory to textile materials is discussed.

The Effect of Strain Hardening on the Dynamic Response of Human Artery Segments

Background: When subjected to time-dependent blood pressure, human arteries undergo large deformations, exhibiting mainly nonlinear hyperelastic type of response. The mechanical response of arteries depends on the health of tissues that comprise the artery walls. Typically, healthy arteries exhibit convex strain hardening under tensile loads, atherosclerotic parts exhibit stiffer response, and aneurysmatic parts exhibit softening response. In reality, arterial dynamics is the dynamics of a propagating pulse, originating in heart ventricle, propagating along aorta, bifurcating, etc. Artery as a whole cannot be simulated as a lump ring, however its cross section can be simulated as a vibrating ring having a phase lag with respect to the other sections, creating a running pressure wave. A full mathematical model would require fluid-solid interaction modeling continuity of blood flow in a compliant vessel and a momentum equation. On the other hand, laboratory testing often uses small-length arteries, the response of which is covered by the present work. In this way, material properties that change along the artery length can be investigated. Objective: The effect of strain hardening on the local dynamic response of human arteries (excluding the full fluid-structure interaction) is examined through appropriate hyperelastic models related to the health condition of the blood vessel. Furthermore, this work aims at constituting a basis for further investigation of the dynamic response of arteries accounting for viscosity. Method: The governing equation of motion is formulated for three different hyperelastic material behaviors, based on the constitutive law proposed by Skalak et al., Hariton, and Mooney-Rivlin, associated with the hardening behavior of healthy, atherosclerotic, and aneurysmatic arteries, respectively. The differences between these modelling implementations are caused by physiology, since aneurysmatic arteries are softer and often sclerotic arteries are stiffer than healthy arteries. The response is investigated by proper normalization of the involved material parameters of the arterial walls, geometry of the arteries, load histories, time effects, and pre-stressing. The effect of each problem parameter on the arterial response has been studied. The peak response of the artery segment is calculated in terms of radial displacements, principal elongations, principal stresses, and strain-energy density. The validity of the proposed analytical models is demonstrated through comparison with previous studies that investigate the dynamic response of arterial models. Results: Important metrics that can be useful to vascular surgery are the radial deformation and the maximum strain-energy density along with the radial resonance frequencies. These metrics are found to be influenced heavily by the nonlinear strain-hardening characteristics of the model and the longitudinal pre-stressing. Conclusion: The proposed formulation permits a systematic and generalizable investigation, which, together with the low computational cost of analysis, makes it a valuable tool for calculating the response of healthy, atherosclerotic, and aneurysmatic arteries. The radial resonance frequencies can explain certain murmures developed in stenotic arteries.

Study on the Dynamic Behavior of Arterial End-to-End Anastomosis

Vascular disorders, such as atherosclerosis and aneurysms are treated by vascular surgery operations, and involve the stitching of disconnected human arteries with themselves or with artificial grafts. Stitching techniques and related suture materials are of great importance. The aim of this study is to assess the mechanical behavior of the connecting region of two, initially separated, human arteries (end-to-end anastomosis) and to provide useful design parameters for a large number of problems, with different geometrical and mechanical properties.

Pretwisted beam subjected to thermal loads: A gradient thermoelastic analogue

ABSTRACT It is well known from the classical torsion theory that the cross section of a prismatic beam subjected to end torsional moments will rotate and warp in the longitudinal direction. Rotation is depicted through the angle of twist per unit length and depends in general on the position along the length of the beam, while the warping function addresses the longitudinal distortion of the unrotated cross sections. In the present study, we consider a prismatic beam that possesses an initial twist which is constant along its length. A thermal field is present along the beam and its ends are loaded with axial forces and torsional moments. The governing equilibrium equations and the corresponding boundary conditions were obtained using an energy variational statement. A one-dimensional gradient thermoelastic analogue is developed. The advantageous aspect of the present study is that the additional (and peculiar) boundary conditions required by the gradient elasticity theory and the related microstructural lengths, analogous to micromechanical lengths, emerge in a natural way from the geometrical characteristics of the beam cross section and the material properties. We have examined various examples with different cross sections and loads to demonstrate the applicability of the model to the design of special yarns useful in smart textiles and thermally activated microdrilling actuators.

Analytical Side-to-Side Related Anastomotic Strategies and Artery Patching

Suture line stress concentration and intimal hyperplasia are related to the long-term complications of end-toside and side-to-side anastomosis. Several factors, such as hemodynamic effects, biological activities and the mechanical properties of the blood vessels, are identified to influence the problem. Yet, it is not completely clear which are the factors that influence most the long-term complications and in what specific way. This study aims to examine if elastic (compliance) mismatch increases the stress concentration and intimal thickening at the suture line. Better compliance may be obtained by using grafts with similar mechanical properties to the host artery or by anastomosis techniques that utilize vein patches and cuffs (Taylor-patch and Miller-cuff anastomosis). The anastomosis model used in this study is a circular cylindrical system consisting of two semi-cylinders, interconnected by two hinges. The internal blood pressure is applied on the arterial walls. The static and dynamic responses are analytically derived in terms of radial and tangential displacements, internal forces and strains of the two blood vessels and rotation of their cross-section. Results suggest that increased elastic mismatch between the artery and the graft may promote elevated intimal thickening due to large incompatible angles at the junction, whereas there is no correlation between elastic mismatch and elevated stress concentration at the suture line. Another interesting application of the present model is the patching of arteries as applied in carotid endarterectomy.

Suture Line Response of End-to-Side Anastomosis: A Stress Concentration Methodology

End-to-side vascular anastomosis has a considerable complexity regarding the suturing of the juncture line between the artery and the graft. The present study proposes a stress–concentration methodology for the prediction of the stress distribution at the juncture line, aiming to provide generic expressions describing the response of an end-to-side anastomosis. The proposed methodology is based on general results obtained from the analysis of pipe connections, a topic that has been investigated in recent years in the field of offshore structural engineering. A key aspect for implementing the stress–concentration–factor approach is the recognition that the axial load due to pressure and flow dynamics exerted along the graft axis controls the “hot spots” on the juncture line, which in turn affects the mechanical response of the sutures. Several parameters, identified to influence the suture line response, are introduced in closed-form expressions for the suture line response calculations. The obtained results compare favorably with finite element results published in the literature. The proposed model predicts analytically the suture line response of end-to-side anastomosis, while capturing the influence of and interdependence among the problem parameters. Lower values of the graft radius, the distance between sequential stitches, and the intersecting angle between the artery and the graft are some of the key parameters that reduce the suture line response. The findings of this study are broad in scope and potentially applicable to improving the end-to-side anastomosis technique through improved functionality of the sutures and optimal selection of materials and anastomosis angle.