Flow-induced wall shear stress in abdominal aortic aneurysms: Part II--pulsatile flow hemodynamics

In continuing the investigation of AAA hemodynamics, unsteady flow-induced stresses are presented for pulsatile blood flow through the double-aneurysm model described in Part I. Physiologically realistic aortic blood flow is simulated under pulsatile conditions for the range of time-average Reynolds numbers 50< or =Re(m) < or =300. Hemodynamic disturbance is evaluated for a modified set of indicator functions which include wall pressure (p(w)), wall shear stress (tau(w)), Wall Shear Stress Gradient (WSSG), time-average wall shear stress (tau(w)*), and time-average Wall Shear Stress Gradient WSSG*. At peak flow, the highest shear stress and WSSG levels are obtained at the distal end of both aneurysms, in a pattern similar to that of steady flow. The maximum values of wall shear stresses and wall shear stress gradients are evaluated as a function of the time-average Reynolds number resulting in a fourth order polynomial correlation. A comparison between numerical predictions for steady and pulsatile flow is presented, illustrating the importance of considering time-dependent flow for the evaluation of hemodynamic indicators.     

Blood flow in abdominal aortic aneurysms: pulsatile flow hemodynamics

Numerical predictions of blood flow patterns and hemodynamic stresses in Abdominal Aortic Aneurysms (AAAs) are performed in a two-aneurysm, axisymmetric, rigid wall model using the spectral element method. Physiologically realistic aortic blood flow is simulated under pulsatile conditions for the range of time-averaged Reynolds numbers 50< or =Re(m)< or =300, corresponding to a range of peak Reynolds numbers 262.5< or =Re(peak) < or = 1575. The vortex dynamics induced by pulsatile flow in AAAs is characterized by a sequence of five different flow phases in one period of the flow cycle. Hemodynamic disturbance is evaluated for a modified set of indicator functions, which include wall pressure (p(w)), wall shear stress (tau(w)), and Wall Shear Stress Gradient (WSSG). At peak flow, the highest shear stress and WSSG levels are obtained downstream of both aneurysms, in a pattern similar to that of steady flow. Maximum values of wall shear stresses and wall shear stress gradients obtained at peak flow are evaluated as a function of the time-average Reynolds number resulting in a fourth order polynomial correlation. A comparison between predictions for steady and pulsatile flow is presented, illustrating the importance of considering time-dependent flow for the evaluation of hemodynamic indicators.     

To what extent does a minimal atherosclerotic plaque alter the arterial wall shear stress distribution? A model study by an electrochemical method

An electrochemical surface shear stress measurement was applied to a model of very thin unilateral arterial stenosis (height of 1/8 of the model pipe diameter with very smooth surface). Three dimensional wall shear stress distribution was measured under steady flow field from a relatively low Reynolds number, Re = 270, to a high Reynolds number, Re = 1200. There was a characteristic high and low wall shear distribution pattern around the stenosis. There were also remarkable high shear stress areas on the opposite wall and both side walls of the stenosis. It was clearly shown that three dimensional structure of the flow field, hence, the wall shear stress distribution, is affected by a minimal change on the arterial wall.     

Flow-induced Wall Shear Stress in Abdominal Aortic Aneurysms: Part II - Pulsatile Flow Hemodynamics

In continuing the investigation of AAA hemodynamics, unsteady flow-induced stresses are presented for pulsatile blood flow through the double-aneurysm model described in Part I. Physiologically realistic aortic blood flow is simulated under pulsatile conditions for the range of time-average Reynolds numbers 50 h Re m h 300. Hemodynamic disturbance is evaluated for a modified set of indicator functions which include wall pressure ( p w ), wall shear stress ( w ), Wall Shear Stress Gradient (WSSG), time-average wall shear stress ( w *), and time-average Wall Shear Stress Gradient WSSG *. At peak flow, the highest shear stress and WSSG levels are obtained at the distal end of both aneurysms, in a pattern similar to that of steady flow. The maximum values of wall shear stresses and wall shear stress gradients are evaluated as a function of the time-average Reynolds number resulting in a fourth order polynomial correlation. A comparison between numerical predictions for steady and pulsatile flow is presented, illustrating the importance of considering time-dependent flow for the evaluation of hemodynamic indicators.     

Measured wall shear stress distribution pattern upstream and downstream of a unilateral stenosis by an electrochemical method

An electrochemical surface shear stress measurement was applied to a model of unilateral arterial stenosis. The unilateral stenosis model was made up of a removable stenosis plug, in an electrochemical shear stress measurement test section with 100 cathodes. Three dimensional wall shear stress distribution was measured under steady flow field. At a relatively low Reynolds number, Re = 270, there was a characteristic high and low wall shear distribution pattern downstream of the unilateral stenosis. There were also remarkable high shear stress areas on the opposite wall up- and downstream, and both side walls of the stenosis upstream. It was clearly shown that detailed three dimensional structure of the flow field must be studied in order to correlate it to pathological findings.     

Flow-induced wall shear stress in abdominal aortic aneurysms: Part I--steady flow hemodynamics

Numerical predictions of blood flow patterns and hemodynamic stresses in Abdominal Aortic Aneurysms (AAAs) are performed in a two-aneurysm, axisymmetric, rigid wall model using the spectral element method. Homogeneous, Newtonian blood flow is simulated under steady conditions for the range of Reynolds numbers 10 < or =Re < or =2265. Flow hemodynamics are quantified by calculating the distributions of wall pressure (p(w)), wall shear stress (tau(w)), Wall Shear Stress Gradient (WSSG). A correlation between maximum values of hemodynamic stresses and Reynolds number is established, and the spatial distribution of WSSG is considered as a hemodynamic force that may cause damage to the arterial wall at an intermediate stage of AAA growth. The temporal distribution of hemodynamic stresses in pulsatile flow and their physical implications in AAA rupture are discussed in Part II of this paper.     

A boundary layer model for wall shear stress in arterial stenosis

This paper proposes a model for wall shear stress in arterial stenosis based on boundary layer theory. Wall shear stress estimates are obtained by solving the momentum integral equation using the method proposed by Walz and applying this method to various stenosis geometries for Reynolds numbers (Re) of Re = 59-1000. Elevated wall shear stress may be of importance when considering thrombosis and vascular erosion in stenosis, as well as the potential for debris from the stenotic area to 'break away' and cause further pathology. The values of shear stress obtained using the model in this study agree well with published values of wall shear stress. When compared to a previously published boundary layer model utilizing the Thwaites method (Reese and Thompson, 1998), the model proposed herein performs better at higher Re while the model utilizing the Thwaites method performs better at lower Re. Wall shear stresses are shown to increase with increasing stenosis (increased area reduction) for a given stenosis length, increase with increasing Re for a given stenosis geometry, and increase for steeper stenosis of the same constriction. The boundary layer model proposed can be easily implemented by clinical researchers to provide in vivo estimates of wall shear stress through arterial stenoses.     

Pulsatile flow in a constricted channel.

A nonuniform channel is used as a simple model of a constricted arterial vessel. Flow patterns have been calculated for pulsatile flow with both sinusoidal and nonsinusoidal flow rates for a range of Reynolds number, Re, and Strouhal number, St. The results show that even for relatively low frequency flows a strong vortex wave will be generated with a complex wall shear stress distribution and peak values much greater than those found in steady or unsteady parallel flow. The vortex wave increases in strength with increasing Re and St, with its total length and wavelength independent of Re but inversely proportional to St. The form of the imposed flow rate is found to have an important effect on the flow and the shear stress distribution.     

The effect of asymmetry in abdominal aortic aneurysms under physiologically realistic pulsatile flow conditions

In the abdominal segment of the human aorta under a patient's average resting conditions, pulsatile blood flow exhibits complex laminar patterns with secondary flows induced by adjacent branches and irregular vessel geometries. The flow dynamics becomes more complex when there is a pathological condition that causes changes in the normal structural composition of the vessel wall, for example, in the presence of an aneurysm. This work examines the hemodynamics of pulsatile blood flow in hypothetical three-dimensional models of abdominal aortic aneurysms (AAAs). Numerical predictions of blood flow patterns and hemodynamic stresses in AAAs are performed in single-aneurysm, asymmetric, rigid wall models using the finite element method. We characterize pulsatile flow dynamics in AAAs for average resting conditions by means of identifying regions of disturbed flow and quantifying the disturbance by evaluating flow-induced stresses at the aneurysm wall, specifically wall pressure and wall shear stress. Physiologically realistic abdominal aortic blood flow is simulated under pulsatile conditions for the range of time-average Reynolds numbers 50 < or = Rem < or = 300, corresponding to a range of peak Reynolds numbers 262.5 < or = Repeak < or = 1575. The vortex dynamics induced by pulsatile flow in AAAs is depicted by a sequence of four different flow phases in one period of the cardiac pulse. Peak wall shear stress and peak wall pressure are reported as a function of the time-average Reynolds number and aneurysm asymmetry. The effect of asymmetry in hypothetically shaped AAAs is to increase the maximum wall shear stress at peak flow and to induce the appearance of secondary flows in late diastole.     

Detailed visualization of pulsatile flow fields produced by modelled arterial stenoses

A multiple trace photochromic method was used to visualize the pulsatile flow field created by modelled arterial stenoses of 38% and 65% area reductions. Using flow parameters similar to those of a medium sized artery in man, the flow patterns at seven axial locations in relation to the stenosis were simultaneously photographed at various times throughout the flow cycle. With the 65% stenosis, the wall shear stress in the vicinity of the reattachment point was found to fluctuate quite strongly during the turbulent phase of the flow cycle, giving rise to instantaneous shear stresses that were at least eight times larger than those measured upstream. For the 38% stenosis, much smaller shear stresses were observed. These and other results are described in detail.     

Some flow visualization and laser-Doppler-velocity measurements in a true-to-scale elastic model of a human aortic arch--a new model technique.

Flow studies were done in an elastic true-to-scale silicone rubber model of an aortic arch to study further hemodynamic influences on atherosclerosis. The model was prepared from a cast of a young woman. A revised model technique was used. The model had a compliance similar to that of the human aortic arch. Velocity measurements were done in the model with a two component laser-Doppler-anemometer in steady and pulsatile flow using a calcium chloride solution with a viscosity of eta = 3.18 mPas and density of rho = 1.28 kg/m3 at 20 degrees C. The time average Reynolds numbers over a whole cycle in the ascending aorta was Re = 1350. The Womersley parameter for pulsatile flow was a = 20. The pulse wave velocity in the ascending aorta was about c = 5.4 m/sec. The secondary flow behavior was discussed for steady and pulsatile flow. Reverse flows were found, especially along the inner radius of the aortic arch in the descending aorta in steady and pulsatile flow and also in small areas of the ascending aorta and at the branches of the aortic arch. The formation of atherosclerotic plaques at preferred local flow regions is discussed.     

Flow in the well: computational fluid dynamics is essential in flow chamber construction

A perfusion system was developed to generate well defined flow conditions within a well of a standard multidish. Human vein endothelial cells were cultured under flow conditions and cell response was analyzed by microscopy. Endothelial cells became elongated and spindle shaped. As demonstrated by computational fluid dynamics (CFD), cells were cultured under well defined but time varying shear stress conditions. A damper system was introduced which reduced pulsatile flow when using volumetric pumps. The flow and the wall shear stress distribution were analyzed by CFD for the steady and unsteady flow field. Usage of the volumetric pump caused variations of the wall shear stresses despite the controlled fluid environment and introduction of a damper system. Therefore the use of CFD analysis and experimental validation is critical in developing flow chambers and studying cell response to shear stress. The system presented gives an effortless flow chamber setup within a 6-well standard multidish.     

The congenital bicuspid aortic valve can experience high-frequency unsteady shear stresses on its leaflet surface

The bicuspid aortic valve (BAV) is a common congenital malformation of the aortic valve (AV) affecting 1% to 2% of the population. The BAV is predisposed to early degenerative calcification of valve leaflets, and BAV patients constitute 50% of AV stenosis patients. Although evidence shows that genetic defects can play a role in calcification of the BAV leaflets, we hypothesize that drastic changes in the mechanical environment of the BAV elicit pathological responses from the valve and might be concurrently responsible for early calcification. An in vitro model of the BAV was constructed by surgically manipulating a native trileaflet porcine AV. The BAV valve model and a trileaflet AV (TAV) model were tested in an in vitro pulsatile flow loop mimicking physiological hemodynamics. Laser Doppler velocimetry was used to make measurements of fluid shear stresses on the leaflet of the valve models using previously established methodologies. Furthermore, particle image velocimetry was used to visualize the flow fields downstream of the valves and in the sinuses. In the BAV model, flow near the leaflets and fluid shear stresses on the leaflets were much more unsteady than for the TAV model, most likely due to the moderate stenosis in the BAV and the skewed forward flow jet that collided with the aorta wall. This additional unsteadiness occurred during mid- to late-systole and was composed of cycle-to-cycle magnitude variability as well as high-frequency fluctuations about the mean shear stress. It has been demonstrated that the BAV geometry can lead to unsteady shear stresses under physiological flow and pressure conditions. Such altered shear stresses could play a role in accelerated calcification in BAVs.     

Pressure drop and flow rate measurements in a human aortic bifurcation cast for steady and pulsatile flow

Pressure drop and flow rate measurements in a rigid cast of a human aortic bifurcation under both steady and physiological pulsatile flow conditions are reported. Integral momentum and mechanical energy balances are used to calculate impedance, spatially averaged wall shear stress and viscous dissipation rate from the data. In the daughter branches, steady flow impedance is within 30% of the Poiseuille flow prediction, while pulsatile flow impedance is within a factor of 2 of fully developed, oscillatory, straight tube flow theory (Womersley theory). Estimates of wall shear stress are in accord with measurements obtained from velocity profiles. Mean pressure drop and viscous dissipation rate are elevated in pulsatile flow relative to steady flow at the mean flow rate, and the exponents of their Reynolds number dependence are in accord with available theory.     

Pulsatile blood flow and oxygen transport past a circular cylinder

The fundamental study of blood flow past a circular cylinder filled with an oxygen source is investigated as a building block for an artificial lung. The Casson constitutive equation is used to describe the shear-thinning and yield stress properties of blood. The presence of hemoglobin is also considered. Far from the cylinder, a pulsatile blood flow in the x direction is prescribed, represented by a time periodic (sinusoidal) component superimposed on a steady velocity. The dimensionless parameters of interest for the characterization of the flow and transport are the steady Reynolds number (Re), Womersley parameter (alpha), pulsation amplitude (A), and the Schmidt number (Sc). The Hill equation is used to describe the saturation curve of hemoglobin with oxygen. Two different feed-gas mixtures were considered: pure O(2) and air. The flow and concentration fields were computed for Re=5, 10, and 40, 0< or =A< or =0.75, alpha=0.25, 0.4, and Schmidt number, Sc=1000. The Casson fluid properties result in reduced recirculations (when present) downstream of the cylinder as compared to a Newtonian fluid. These vortices oscillate in size and strength as A and alpha are varied. Hemoglobin enhances mass transport and is especially important for an air feed which is dominated by oxyhemoglobin dispersion near the cylinder. For a pure O(2) feed, oxygen transport in the plasma dominates near the cylinder. Maximum oxygen transport is achieved by operating near steady flow (small A) for both feed-gas mixtures. The time averaged Sherwood number, Sh, is found to be largely influenced by the steady Reynolds number, increasing as Re increases and decreasing with A. Little change is observed with varying alpha for the ranges investigated. The effect of pulsatility on Sh is greater at larger Re. Increasing Re aids transport, but yields a higher cylinder drag force and shear stresses on the cylinder surface which are potentially undesirable.     

Shear stress induced stimulation of mammalian cell metabolism

A flow apparatus has been developed for the study of the metabolic response of anchorage-dependent cells to a wide range of steady and pulsatile shear stresses under well-controlled conditions. Human umbilical vein endothelial cell monolayers were subjected to steady shear stresses of up to 24 dynes/cm(2), and the production of prostacyclin was determined. The onset of flow led to a burst in prostacyclin production which decayed to a long term steady state rate (SSR). The SSR of cells exposed to flow was greater than the basal release level, and increased linearly with increasing shear stress. This study demonstrates that shear stress in certain ranges may not be detrimental to mammalian cell metabolism. In fact, throughout the range of shear stresses studied, metabolite production is maximized by maximizing shear stress.     

Sialyl Lewis(x)/E-selectin-mediated rolling in a cell-free system.

Selections mediate transient adhesion of neutrophils to stimulated endothelial cells at sites of inflammation by binding counter-receptors that present carbohydrates such as sialyl Lewis(x). We have developed a cell-free adhesion assay using sialyl Lewis(x)-coated microspheres and E-selection-IgG chimera-coated substrates to investigate the premise that rolling primarily results from functional properties of selection-carbohydrate bonds, whereas cellular morphology and signaling act as secondary effects. Sialyl Lewis(x)-coated microspheres attach to and roll over E-selectin-IgG chimera-coated substrates between the physiological wall shear stresses of 0.7 and 2 dynes/cm2. Rolling velocities vary with time and depend on E-selectin-IgG chimera site density and wall shear stress. Our results show that sialyl Lewis(x) is a minimal functional recognition element required for rolling on E-selectin under flow.     

Fluid-Structure Interaction Analysis of Pulsatile Flow within a Layered and Stenotic Aorta

In this paper, the hemodynamic characteristics of blood flow and stress distribution in a layered and stenotic aorta are investigated. By introducing symmetrical and unsymmetrical stenosis, the influence of stenosis morphology and stenotic ratio on the coupled dynamic responses of aorta is clarified. In the analysis, the in-vivo pulsatile waveforms and fully fluid–structure interaction (FSI) between the layered elastic aorta and the blood are considered. The results show that the fluid domain is abnormal in the stenotic aorta, and the whirlpool forms at the obstructed and downstream unobstructed regions. The maximum wall shear stresses appear at the throat of the stenosis. Downstream region appears low and oscillated shear stresses. In addition, along with the increase of the stenotic ratio, the amplitude of the maximum shear stress will be intensively increased and localized, and the sensitivity is also increased. In the aorta with unsymmetrical stenosis, the Von Mises stresses reach the peak value at the side with the surface protuberance, but they are reduced at the side with no protuberance. The sign variation of the layer interface shear stresses near the throat indicates the variation of the shear direction which increases the opportunity of shear damage at the transition plane. Moreover, the shear stress levels at the fluid-solid and intima-media interfaces are higher than that at the media-adventitia interface. The unsymmetrical stenosis causes higher stresses at the side with the surface protuberance than symmetrical one, but lower at the side with no protuberance. These results provide an insight in the influence of the stenosis, as well as its morphology, on the pathogenesis and pathological evolution of some diseases, such as arteriosclerosis and aortic dissection.     

Numerical analysis of flow through a severely stenotic carotid artery bifurcation

The results of computational simulations may supplement MR and other in vivo diagnostic techniques to provide an accurate picture of the hemodynamics in particular vessels, which may help demonstrate the risks of embolism or plaque rupture posed by particular plaque deposits. In this study, a model based on an endarterectomy specimen of the plaque in a carotid bifurcation was examined. The flow conditions include steady flow at Reynolds numbers of 300, 600, and 900 as well as unsteady pulsatile flow. Both dynamic pressure and wall shear stress are very high, with shear values up to 70 N/m2, proximal to the stenosis throat in the internal carotid artery, and both vary significantly through the flow cycle. The wall shear stress gradient is also strong along the throat. Vortex shedding is observed downstream of the most severe occlusion. Two turbulence models, the Chien and Goldberg varieties of k-epsilon, are tested and evaluated for their relevance in this geometry. The Chien model better captures phenomena such as vortex shedding. The flow distal to stenosis is likely transitional, so a model that captures both laminar and turbulent behavior is needed.     

Combined MR imaging and numerical simulation of flow in realistic arterial bypass graft models

We report methods for (a) transforming a three-dimensional geometry acquired by magnetic resonance angiography (MRA) in vivo, or by imaging a model cast, into a computational surface representation, (b) use of this to construct a three dimensional numerical grid for computational fluid dynamic (CFD) studies, and (c) use of the surface representation to produce a stereo-lithographic replica of the real detailed geometry, at a scale convenient for detailed magnetic resonance imaging (MRI) flow studies. This is applied to assess the local flow field in realistic geometry arterial bypass grafts. Results from a parallel numerical simulation and MRI measurement of flow in an aorto-coronary bypass graft with various inlet flow conditions demonstrate the strong influence of the graft inlet waveform on the perianastomotic flow field. A sinusoidal and a multi harmonic coronary flow waveform both with a mean Reynolds number (Re) of 100 and a Womersley parameter of 2.7 were applied at the graft inlet. A weak axial flow separation region just distal to the toe was found in sinusoidal flow near end deceleration (Re = 25). At the same location and approximately the same point in the cycle (Re = 30) but in coronary flow, the axial flow separation was stronger and more spatially pronounced. No axial flow separation occurred in steady flow for Re = 100. Numerical predictions indicate a region in the vicinity of the suture line (where there is a local narrowing of the graft) with a wall shear magnitude in excess of five times that associated with fully developed flow at the graft inlet.