An in vitro comparison of the hemodynamics of two inferior vena cava filters

AbstractPurpose: The effectiveness of an inferior vena cava (IVC) filter in preventing pulmonary embolism while preserving caval flow is significantly affected by its hemodynamic characteristics. Flow fields surrounding two types of IVC filters were compared to assess how the design of a filter may influence performance. Methods: The 12F Titanium Greenfield and VenaTech LGM inferior vena cava filters were studied in vitro with a noninvasive flow visualization technique, the photochromic flow visualization and measurement technique. Axial velocity profiles and wall shear stress distributions were measured. These results were compared with analytical data corresponding to the flow field in the absence of a filter to determine the relative extent of the flow disturbances. Results: The reductions in near-wall axial velocity and wall shear stress caused by the VenaTech filter were more extensive and severe than those caused by the Greenfield filter. These changes were the consequence of differences in the geometry and dimensions of the struts of the two filters. The measurements showed the flow fields to be laminar, with no evidence of turbulence in both cases. Conclusion: Two factors that have been linked to thrombogenesis, near-wall velocity and wall-shear stress, were significantly affected by the larger frontal profile area of the VenaTech filter. Although a larger area may increase clot-trapping efficiency, as shown by previous studies, the reduced near-wall velocities and wall shear stresses may increase the potential for thrombogenesis and, thus, caval occlusion. In contrast to other in vitro flow visualization studies, no turbulence was observed with either filter. (J Vasc Surg 2000;31:539-49.

Defining the limitations of measurements from Doppler spectral recordings

AbstractPurpose:The purpose of this study was to determine whether Doppler measurements of peak velocity and four other quantitative measures of spectral shape are affected significantly by the site of the Doppler recording in relation to the location of the maximum stenosis.Method: Continuous-wave and pulsed Doppler recordings were made distal to a 70% (area reduction or 45% diameter reduction) asymmetric stenosis in an in vitro flow model under steady and pulsatile flow conditions. Recordings were taken at six different locations proximal and distal to the stenosis. A photochromic dye technique was used to visualize the actual flow field in the model.Results: Distal to the stenosis, the flow visualization results demonstrated a strong radial and axial variation of the velocity field and thus explained why the Doppler measurements of peak frequency and spectral broadening were strongly dependent on the recording site. The peak frequency was maximum within the throat of the stenosis and returned to the prestenotic value five tube diameters distal to the stenosis. Other measurements of spectral broadening and spectral shape varied greatly depending on the location of the recording site in the poststenotic region. Higher order spectral moments such as the coefficient of kurtosis were found to exhibit large temporal variability, which makes them inappropriate as diagnostic indicators.Conclusions: Because of the complex nature of the poststenotic flow field, these results clearly demonstrate that no single Doppler measurement can accurately quantify the severity of a stenosis. Of the Doppler measurements only peak velocity is related to the severity of stenosis. Reproducible peak velocity measurements are obtained only if the Doppler sample volume is positioned at or very near the throat of the stenosis and at an appropriate radial site that may not necessarily be at the center of the vessel. (J Vasc Surg 1996;24:34-45.

In vitro assessment of the hemodynamic effects of a partial occlusion in a vena cava filter

Purpose:Flow fields surrounding a vena cava filter were studied with a noninvasive method of flow visualization to examine the underlying hemodynamic factors that contribute to its function and patency.Methods:The photochromic technique was used to measure axial velocity profiles and wall shear stress distributions in a 12F titanium Greenfield filter partially occluded with a simulated volume of entrapped thrombi. These results were compared with similar measurements obtained for an unoccluded filter and with a theoretic prediction of the velocity profile and wall shear stress without a vena cava filter. Shear stress distributions were obtained along the vessel wall and for the partially occluded filter along the surface of the simulated clot.Results:The unoccluded filter was observed to have little effect on the flow field. In the case of the partially occluded filter, the results of these measurements show that caval blood flow is preserved by the creation of an annular region of increased flow around the periphery of the clot. Within this region high shear stresses that develop as a result of the increased flow are observed along the vessel wall and along the surface of the simulated clot. No vortices or turbulence were observed with either the unoccluded or the partially occluded filter.Conclusions:The elevated levels of shear stress may be a factor in the lysis of trapped clots observed in vivo. Although increased shear stress is reported to cause thrombogenesis in an in vivo study in canines, particularly under turbulent flow conditions, the levels of shear measured in this study around the simulated clot were well below such values

The relationship between wall shear stress distributions and intimal thickening in the human abdominal aorta

Abstract Purpose The goal of this work was to determine wall shear stress (WSS) patterns in the human abdominal aorta and to compare these patterns to measurements of intimal thickness (IT) from autopsy samples. Methods The WSS was experimentally measured using the laser photochromic dye tracer technique in an anatomically faithful in vitro model based on CT scans of the abdominal aorta in a healthy 35-year-old subject. IT was quantified as a function of circumferential and axial position using light microscopy in ten human autopsy specimens. Results The histomorphometric analysis suggests that IT increases with age and that the distribution of intimal thickening changes with age. The lowest WSS in the flow model was found on the posterior wall inferior to the inferior mesenteric artery, and coincided with the region of most prominent IT in the autopsy samples. Local geometrical features in the flow model, such as the expansion at the inferior mesenteric artery (common in younger individuals), strongly influenced WSS patterns. The WSS was found to correlate negatively with IT (r2 = 0.3099; P = 0.0047). Conclusion Low WSS in the abdominal aorta is co-localized with IT and may be related to atherogenesis. Also, rates of IT in the abdominal aorta are possibly influenced by age-related geometrical changes.</p

The relationship between wall shear stress distributions and intimal thickening in the human abdominal aorta

PURPOSE:The goal of this work was to determine wall shear stress (WSS) patterns in the human abdominal aorta and to compare these patterns to measurements of intimal thickness (IT) from autopsy samples.METHODS:The WSS was experimentally measured using the laser photochromic dye tracer technique in an anatomically faithful in vitro model based on CT scans of the abdominal aorta in a healthy 35-year-old subject. IT was quantified as a function of circumferential and axial position using light microscopy in ten human autopsy specimens.RESULTS:The histomorphometric analysis suggests that IT increases with age and that the distribution of intimal thickening changes with age. The lowest WSS in the flow model was found on the posterior wall inferior to the inferior mesenteric artery, and coincided with the region of most prominent IT in the autopsy samples. Local geometrical features in the flow model, such as the expansion at the inferior mesenteric artery (common in younger individuals), strongly influenced WSS patterns. The WSS was found to correlate negatively with IT (r2 = 0.3099; P = 0.0047).CONCLUSION:Low WSS in the abdominal aorta is co-localized with IT and may be related to atherogenesis. Also, rates of IT in the abdominal aorta are possibly influenced by age-related geometrical changes