Morphological and hemodynamical alterations in brachial artery and cephalic vein. An image‐based study for preoperative assessment for vascular access creation

The current study aims to computationally evaluate the effect of right upper arm position on the geometric and hemodynamic characteristics of the brachial artery (BA) and cephalic vein (CV) and, furthermore, to present in detail the methodology to characterise morphological and hemodynamical healthy vessels. Ten healthy volunteers were analysed in two configurations, the supine (S) and the prone (P) position. Lumen 3D surface models were constructed from images acquired from a non-contrast MRI sequence. Then, the models were used to numerically compute the physiological range of geometric (n = 10) and hemodynamic (n = 3) parameters in the BA and CV. Geometric parameters such as curvature and tortuosity, and hemodynamic parameters based on wall shear stress (WSS) metrics were calculated with the use of computational fluid dynamics. Our results highlight that changes in arm position had a greater impact on WSS metrics of the BA by altering the mean and maximum blood flow rate of the vessel. Whereas, curvature and tortuosity were found not to be significantly different between positions. Inter-variability was associated with antegrade and retrograde flow in BA, and antegrade flow in CV. Shear stress was low and oscillatory shear forces were negligible. This data suggests that deviations from this state may contribute to the risk of accelerated intimal hyperplasia of the vein in arteriovenous fistulas. Therefore, preoperative conditions coupled with post-operative longitudinal data will aid the identification of such relationships

Imaging in Vascular Access

This review examines four imaging modalities; ultrasound (US), digital subtraction angiography (DSA), magnetic resonance imaging (MRI) and computed tomography (CT), that have common or potential applications in vascular access (VA). The four modalities are reviewed under their primary uses, techniques, advantages and disadvantages, and future directions that are specific to VA. Currently, US is the most commonly used modality in VA because it is cheaper (relative to other modalities), accessible, non-ionising, and does not require the use of contrast agents. DSA is predominantly only performed when an intervention is indicated. MRI is limited by its cost and the time required for image acquisition that mainly confines it to the realm of research where high resolution is required. CT’s short acquisition times and high resolution make it useful as a problem-solving tool in complex cases, although accessibility can be an issue. All four imaging modalities have advantages and disadvantages that limit their use in this particular patient cohort. Current imaging in VA comprises an integrated approach with each modality providing particular uses dependent on their capabilities. MRI and CT, which currently have limited use, may have increasingly important future roles in complex cases where detailed analysis is required

Haemodynamics and flow modification stents for peripheral arterial disease:a review

Endovascular stents are widely used for the treatment of peripheral arterial disease (PAD). However, the development of in-stent restenosis and downstream PAD progression remain a challenge. Stent revascularisation of PAD causes arterial trauma and introduces abnormal haemodynamics, which initiate complicated biological processes detrimental to the arterial wall. The interaction between stent struts and arterial cells in contact, and the blood flow field created in a stented region, are highly affected by stent design. Spiral flow is known as a normal physiologic characteristic of arterial circulation and is believed to prevent the development of flow disturbances. This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics. Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates. This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD

Effect of posture change on the geometric features of the healthy carotid bifurcation

Segmented cross-sectional MRI images were used to construct 3-D virtual models of the carotid bifurcation in ten healthy volunteers. Geometric features, such as bifurcation angle, internal carotid artery (ICA) angle, planarity angle, asymmetry angle, tortuosity, curvature, bifurcation area ratio, ICA/common carotid artery (CCA), external carotid artery (ECA)/CCA, and ECA/ICA diameter ratios, were calculated for both carotids in two head postures: 1) the supine neutral position; and 2) the prone sleeping position with head rotation to the right (∼80°). The results obtained have shown that head rotation causes 1) significant variations in bifurcation angle [32% mean increase for the right carotid (RC) and 21% mean decrease for the left carotid (LC)] and internal carotid artery angle (97% mean increase for the RC, 43% mean decrease for the LC); 2) a slight increase in planarity and asymmetry angles for both RC and LC; 3) minor and variable curvature changes for the CCA and for the branches; 4) slight tortuosity changes for the braches but not for the CCA; and 5) unsubstantial alterations in area and diameter ratios (percentage changes < 10). The significant geometric changes observed in most subjects with head posture may also cause significant changes in bifurcation hemodynamics and warrant future investigation of the hemodynamic parameters related to the development of atherosclerotic disease such as low oscillating wall shear stress and particle residence times

Head posture influences the geometric and hemodynamic features on the healthy human carotid bifurcation

Atherosclerosis is the third leading cause of morbidity and mortality in the Western world. Low and oscillating wall shear stress (WSS) regions have been previously reported as parameters that correlate with the development of atherosclerosis. In this study we investigated geometric and hemodynamic changes in the carotid bifurcation as a result of posture change. Data from magnetic resonance imaging (MRI) were used to construct three dimensional (3D) surface models and computational fluid dynamic (CFD) fields. Two healthy volunteers were imaged by MRI in three different head postures: a) the supine neutral (N) head position, b) the prone position with leftward head rotation (LR) up to 80° and c) the prone position with rightward head rotation (RR) up to 80o. The area exposure to unfavorable hemodynamics, based on thresholds set for oscillatory shear index (OSI), WSS and relative residence times (RRT), was used to quantify the hemodynamic impact on the wall. Significant change in the hemodynamic burden on the wall was found for the OSI. The velocity profile at the common carotid artery (CCA) upstream of the carotid bifurcation (CB) was investigated at the supine and RR prone position for six healthy volunteers. The results indicated that blood flow rate decreased at peak systole, for the prone position for both the right and left CCAs

Effect of posture change on the geometric features of the healthy carotid bifurcation

Segmented cross sectional MRI images were used to construct 3D virtual models of the carotid bifurcation in 5 healthy volunteers. Geometric features such as bifurcation angle, planarity angle, asymmetry angle tortuosity and curvature were calculated for the normal head posture and were compared to the equivalent values acquired with the head rotated clockwise by up to 80 degrees. The results obtained have shown that head rotation causes: 1) significant variations in bifurcation angle, planarity angle, asymmetry angle and internal carotid artery angle 2) tortuosity changes for the braches but not for the common carotid and 3) significant curvature changes for the common carotid artery (CCA) but not for the branches. The significant geometric changes observed in most subjects with head posture, may cause significant changes in hemodynamics and warrants future investigation of the hemodynamic parameters related to the development of atherosclerotic disease such as low oscillating wall shear stress and particle residence times

CFD challenge: Solutions using the commercial finite volume solver, fluent

This work is a collaborative effort between the Biomechanics and Living System Analysis Laboratory (BIOLISYS) in Cyprus and the Biomechanics Laboratory of IACM/FORTH in Greece. Both labs combine interdisciplinary skills from engineering, medicine and biology to provide solutions to clinical problems associated with cardiovascular and other diseases. For this study, numerical flow simulations were performed using: a) open source software VMTK and commercial software ICEM CFD as pre-processors, b) the finite volume based solver Fluent and c) Tecplot 360 (Amtec Inc.) for post-processing

Combined anti-angiogenic and cytotoxic treatment of a solid tumour: in silico investigation of a xenograft animal model’s digital twin

Anti-angiogenic (AA) treatments have received significant research interest due to the key role of an-giogenesis in cancer progression. AA agents can have a strong effect on cancer regression, by blockingnew vessels and reducing the density of the existing vasculature. Moreover, in a process termed vascularnormalisation, AA drugs can improve the abnormal structure and function of the tumour vasculature,enhancing the delivery of chemotherapeutics to the tumour site. Despite their promising potential, animproved understanding of AA treatments is necessary to optimise their administration as a monotherapy orin combination with other cancer treatments. In this work we present anin silicomultiscale cancer modelwhich is used to systematically interrogate the role of individual mechanisms of action of AA drugs intumour regression. Focus is placed on the reduction of vascular density and on vascular normalisation througha parametric study, which are considered either as monotherapies or in combination with conventional/metronomic chemotherapy. The model is specified to data from a mammary carcinoma xenograft in im-munodeficient mice, to enhance the physiological relevance of model predictions. Our results suggest thatconventional chemotherapy might be more beneficial when combined with AA treatments, hindering tumourgrowth without causing excessive damage on healthy tissue. Notably, metronomic chemotherapy has shownsignificant potential in stopping tumour growth with minimal toxicity, even as a monotherapy. Our findingsunderpin the potential of ourin silicoframework for non-invasive and cost-effective evaluation of treatmentstrategies, which can enhance our understanding of combined therapeutic strategies and contribute towardsimproving cancer treatment management