Hemodynamic conditions in a failing peripheral artery bypass graft.

Journal of Vascular Surgery
Patrick M McGahAlberto Aliseda

Abstract

The mechanisms of restenosis in autogenous vein bypass grafts placed for peripheral artery disease are not completely understood. We investigated the role of hemodynamic stress in a case study of a revised bypass graft that failed due to restenosis. The morphology of the lumen was reconstructed from a custom three-dimensional ultrasound system. Scans were taken at 1, 6, and 16 months after a patch angioplasty procedure. Computational hemodynamic simulations of the patient-specific model provided the blood flow features and the hemodynamic stresses on the vessel wall at the three times studied. The vessel was initially free of any detectable lesions, but a 60% diameter-reducing stenosis developed during the 16-month study interval. As determined from the simulations, chaotic and recirculating flow occurred downstream of the stenosis due to the sudden widening of the lumen at the patch location. Curvature and a sudden increase in the lumen cross-sectional area induced these flow features that are hypothesized to be conducive to intimal hyperplasia. Favorable agreement was found between simulation results and in vivo Doppler ultrasound velocity measurements. Transitional and chaotic flow occurs at the site of the revision, inducin...Continue Reading

References

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Mar 29, 2003·Journal of Vascular Surgery·Daniel F LeottaD Eugene Strandness
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Jun 2, 2009·Journal of Vascular Surgery·Philip P GoodneyRobert M Zwolak

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Citations

Sep 18, 2012·The Journal of Thoracic and Cardiovascular Surgery·Afshin EhsanIris Z Jaffe
May 22, 2016·Vascular and Endovascular Surgery·R Eugene ZierlerFlorence H Sheehan
Mar 18, 2016·Vascular and Endovascular Surgery·Francesco De SantisGuido Martini
May 2, 2017·Frontiers in Physiology·Francesca DonadoniVanessa Díaz-Zuccarini

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