Sergio Giordana

Local and Global Geometric Influence on Steady Flow in Distal Anastomoses of Peripheral Bypass Grafts

We consider the effect of geometrical configuration on the steady flow field of representative geometries from an in vivo anatomical data set of end-to-side distal anastomoses constructed as part of a peripheral bypass graft. Using a geometrical classification technique, we select the anastomoses of three representative patients according to the angle between the graft and proximal host vessels (GPA) and the planarity of the anastomotic configuration. The geometries considered include two surgically tunneled grafts with shallow GPAs which are relatively planar but have different lumen characteristics, one case exhibiting a local restriction at the perianastomotic graft and proximal host whilst the other case has a relatively uniform cross section. The third case is nonplanar and characterized by a wide GPA resulting from the graft being constructed superficially from an in situ vein. In all three models the same peripheral resistance was imposed at the computational outflows of the distal and proximal host vessels and this condition, combined with the effect of the anastomotic geometry, has been observed to reasonably reproduce the in vivo flow split. By analyzing the flow fields we demonstrate how the local and global geometric characteristics influences the distribution of wall shear stress and the steady transport of fluid particles. Specifically, in vessels that have a global geometric characteristic we observe that the wall shear stress depends on large scale geometrical factors, e.g., the curvature and planarity of blood vessels. In contrast, the wall shear stress distribution and local mixing is significantly influenced by morphology and location of restrictions, particular when there is a shallow GPA. A combination of local and global effects are also possible as demonstrated in our third study of an anastomosis with a larger GPA. These relatively simple observations highlight the need to distinguish between local and global geometric influences for a given reconstruction. We further present the geometrical evolution of the anastomoses over a series of follow-up studies and observe how the lumen progresses towards the faster bulk flow of the velocity in the original geometry. This mechanism is consistent with the luminal changes in recirculation regions that experience low wall shear stress. In the shallow GPA anastomoses the proximal part of the native host vessel occludes or stenoses earlier than in the case with wide GPA. A potential contribution to this behavior is suggested by the stronger mixing that characterizes anastomoses with large GPA.

Three-dimensional reconstruction of autologous vein bypass graft distal anastomoses imaged with magnetic resonance: clinical and research applications.

High-resolution magnetic resonance imaging was combined with computational modeling to create focused three-dimensional reconstructions of the distal anastomotic region of autologous vein peripheral bypass grafts in a preliminary series of patients. Readily viewed on a personal computer or printed as hard copies, a detailed appreciation of in vivo postoperative features of the anastomosis is possible. These reconstructions are suitable for analysis of geometric features, including vessel caliber, tortuosity, anastomotic angles, and planarity. Some potential clinical and research applications of this technique are discussed.

Automatic reconstruction of a patient-specific high-order surface representation and its application to mesh generation for CFD calculations

We describe a set of procedures for the shape reconstruction and mesh generation of unstructured high-order spatial discretization of patient-specific geometries from a series of medical images and for the simulation of flows in these meshes using a high-order hp-spectral solver. The reconstruction of the shape of the boundary is based on the interpolation of an implicit function through a set of points obtained from the segmentation of the images. This approach is favoured for its ability of smoothly interpolating between sections of different topology. The boundary of the object is initially represented as an iso-surface of an implicit function defined in terms of radial basis functions. This surface is approximated by a triangulation extracted by the method of marching cubes. The triangulation is then suitably smoothed and refined to improve its quality and permit its approximation by a quilt of bi-variate spline surface patches. Such representation is often the standard input format required for state-of-the-art mesh generators. The generation of the surface patches is based on a partition of the triangulation into Voronoi regions and dual Delaunay triangulations with an even number of triangles. The quality of the triangulation is optimized by imposing that the distortion associated with the energy of deformation by harmonic maps is minimized. Patches are obtained by merging adjacent triangles and this representation is then used to generate a mesh of linear elements using standard generation techniques. Finally, a mesh of high-order elements is generated in a bottom-up fashion by creating the additional points required for the high-order interpolation and projecting them on the edges and surfaces of the quilt of patches. The methodology is illustrated by generating meshes for a by-pass graft geometry and calculating high-order CFD solutions in these meshes.

Applications and test cases

Although medical imaging can provide relatively accurate geometric data of in vivo bypass grafts, as will be discussed in Section 12.1.2, to obtain an understanding of the general flow features it is instructive to consider an idealisation of a distal bypass graft. In this example we therefore consider the problem shown in Fig. 12.1, which consists of three vessels, all of the same diameter D, where the bypass (connecting) vessel has a centreline length of 3D and the host vessel is represented by two co-aligned vessels of lengths 5D (distal) and 10D (proximal) from the junction.