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.     

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.     

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.     

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.     

Local hemodynamics affect monocytic cell adhesion to a three-dimensional flow model coated with E-selectin.

Monocyte adhesion to the endothelium depends on concentrations of receptors/ligands, local concentrations of chemoattractants, monocyte transport to the endothelial surface and hemodynamic forces. Monocyte adhesion to the inert surface of a three-dimensional perfusion model was shown to correlate inversely with wall shear stress, but was also affected by flow patterns which influenced the near-wall cell availability. We hypothesized that (a) under the same flow conditions, insolubilized E-selectin on the model's surface may mediate adhesive interactions at higher wall shear stresses, compared to an uncoated model, and (b) pulsatile flow may modify the adhesion profile obtained under steady flow. An axisymmetric flow model with a stenosis and a sudden expansion produced a range of wall shear stresses and a separated flow with recirculation and reattachment. Pre-activated U937 cells were perfused through the model under either steady (Re = 100, 140) or pulsatile (Remean = 107) flow. The velocity field was characterized through computational fluid dynamics and validated by inert particle tracking. Surface E-selectin greatly increased cell adhesion in all regions at Re = 100 and 140, compared to an uncoated model under the same flow conditions. In regions where the cells near the wall were abundant (taper and stenosis), adhesion to E-selectin correlated with the reciprocal of local wall shear stress when flow was steady. Pulsatile flow distributed the adherent cells more evenly throughout the coated model. Hence, characterizing both the local hemodynamics and the biological activity on the vessel wall is important in leukocyte adhesion.     

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.     

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.     

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.     

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.     

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.     

Flush-mounted hot film anemometer accuracy in pulsatile flow

The accuracy of a flush-mounted hot film anemometer probe for wall shear stress measurements in physiological pulsatile flows was evaluated in fully developed pulsatile flow in a rigid straight tube. Measured wall shear stress waveform based on steady flow anemometer probe calibrations were compared to theoretical wall shear stress waveforms based on well-established theory and measured flow rate waveforms. The measured and theoretical waveforms were in close agreement during systole (average deviation of 14 percent at peak systole). As expected, agreement was poor during diastole because of flow reversal and diminished frequency response at low shear rate.     

Flush mounted hot film anemometer measurement of wall shear stress distal to a tri-leaflet valve for Newtonian and non-Newtonian blood analog fluids

Wall shear stress has been measured by flush-mounted hot film anemometry distal to an Ionescu-Shiley tri-leaflet valve under pulsatile flow conditions. Both Newtonian (aqueous glycerol) and non-Newtonian (aqueous polyacrylamide) blood analog fluids were investigated. Significant differences in the axial distribution of wall shear stress between the two fluids are apparent in flows having nearly identical Reynolds numbers. The Newtonian fluid exhibits a (peak) wall shear rate which is maximized near the valve seat (30 mm) and then decays to a fully developed flow value (by 106 mm). In contrast, the shear rate of the non-Newtonian fluid at 30 mm is less than half that of the Newtonian fluid and at 106 mm is more than twice that of the Newtonian fluid. It is suggested that non-Newtonian rheology influences valve flow patterns either through alterations in valve opening associated with low shear separation zones behind valve leaflets, or because of variations in the rate of jet spreading. More detailed studies are required to clarify the mechanisms. The Newtonian wall shear stresses for this valve are low. The highest value observed anywhere in the aortic chamber was 2.85 N/m2 at a peak Reynolds number of 3694.     

Velocity measurements in steady flow through axisymmetric stenoses at moderate Reynolds numbers

The velocity field in the neighborhood of axisymmetric constrictions in rigid tubes was investigated using laser Doppler anemometry and flow visualization. Upstream flow conditions were steady; and Reynolds numbers were in the range 500-2000, values which are representative of the larger arteries in humans. Stenoses of 25, 50 and 75% area reduction were studied. Velocity profiles are presented in sufficient detail to allow comparison with computational biofluid dynamics models. Wall shear stresses were estimated from the near wall velocity gradient, and the nature of observed poststenotic flow disturbances is discussed. Results indicate that flow disturbances of discrete oscillation frequency may be more valuable than turbulence as an indicator of early stages of stenosis development. Additionally, despite the fact that poststenotic turbulence exists for the higher degrees of stenosis and Reynolds numbers, the resulting wall shear stresses are only three to four times greater than the Poiseuille value and are considerably less than the wall shear stress within the stenosis itself.     

Computational study of the effect of geometric and flow parameters on the steady flow field at the rabbit aorto-celiac bifurcation

Arterial hemodynamic forces may play a role in the localization of early atherosclerotic lesions. We have been developing numerical techniques based on overset or "Chimera" type formulations to solve the Navier-Stokes equations in complex geometries simulating arterial bifurcations. This paper presents three-dimensional steady flow computations in a model of the rabbit aorto-celiac bifurcation. The computational methods were validated by comparing the numerical results to previously-obtained flow visualization data. Once validated, the numerical algorithms were used to investigate the sensitivity of the computed flow field and resulting wall shear stress distribution to various geometric and hemodynamic parameters. The results demonstrated that a decrease in the extent of aortic taper downstream of the celiac artery induced looping fluid motion along the lateral walls of the aorta and shifted the peak wall shear stress from downstream of the celiac artery to upstream. Increasing the flow Reynolds number led to a sharp increase in spatial gradients of wall shear stress. The flow field was highly sensitive to the flow division ratio, i.e., the fraction of total flow rate that enters the celiac artery, with larger values of this ratio leading to the occurrence of flow separation along the dorsal wall of the aorta. Finally, skewness of the inlet velocity profile had a profound impact on the wall shear stress distribution near the celiac artery. While not physiological due to the assumption of steady flow, these results provide valuable insight into the fluid physics at geometries simulating arterial bifurcations.     

Modeling pulsatile flow in aortic aneurysms: effect of non-Newtonian properties of blood

Pulsatile flow in an axisymmetric rigid-walled model of an abdominal aorta aneurysm was analyzed numerically for various aneurysm dilations using physiologically realistic resting waveform at time-averaged Reynolds number of 300 and peak Reynolds number of 1607. Discretization of the governing equations was achieved using a finite element scheme based on the Galerkin method of weighted residuals. Comparisons with previously published work on the basis of special cases were performed and found to be in excellent agreement. Our findings indicate that the velocity fields are significantly affected by non-Newtonian properties in pathologically altered configurations. Non-Newtonian fluid shear stress is found to be greater than Newtonian fluid shear stress during peak systole. Further, the maximum shear stress is found to occur near the distal end of AAA during peak systole. The impact of non-Newtonian blood flow characteristics on pressure compared to Newtonian model is found insignificant under resting conditions. Viscous and inertial forces associated with blood flow are responsible for the changes in the wall that result in thrombus deposition and dilation while rupture of AAA is more likely determined by much larger mechanical stresses imposed by pulsatile pressure on the wall of AAA.     

Numerical study of the impact of non-Newtonian blood behavior on flow over a two-dimensional backward facing step

Endothelial cell (EC) responsiveness to shear stress is essential for vasoregulation and plays a role in atherogenesis. Although blood is a non-Newtonian fluid, EC flow studies in vitro are typically performed using Newtonian fluids. The goal of the present study was to determine the impact of non-Newtonian behavior on the flow field within a model flow chamber capable of producing flow disturbance and whose dimensions permit Reynolds and Womersley numbers comparable to those present in vivo. We performed two-dimensional computational fluid dynamic simulations of steady and pulsatile laminar flow of Newtonian and non-Newtonian fluids over a backward facing step. In the non-Newtonian simulations, the fluid was modeled as a shear-thinning Carreau fluid. Steady flow results demonstrate that for Re in the range 50-400, the flow recirculation zone downstream of the step is 22-63% larger for the Newtonian fluid than for the non-Newtonian fluid, while spatial gradients of shear stress are larger for the non-Newtonian fluid. In pulsatile flow, the temporal gradients of shear stress within the flow recirculation zone are significantly larger for the Newtonian fluid than for the non-Newtonian fluid. These findings raise the possibility that in regions of flow disturbance, EC mechanotransduction pathways stimulated by Newtonian and non-Newtonian fluids may be different.     

Flow measurements in a human femoral artery model with reverse lumen curvature

Flow visualization and wall pressure measurements were made in a smooth reverse curvature model that conformed to the gentle "s" shape of a left femoral artery angiogram of a patient in a clinical trial. Observed lesion localization at the inner (lesser) curvatures appeared to be associated with secondary flows in the wall vicinity directed toward the inner curvatures that tended to reverse direction in the flow entering the reverse curvature region. Moderate flow resistance increases of about 20 percent above the Poiseuille flow relation were found at the higher physiological Reynolds numbers Re above about 600-700 and thus Dean numbers for steady flow. For pulsatile flow simulation, flow resistances did not increase up to the largest Re of 470 tested. Apparently, the large variations in velocity during the cardiac cycle disrupted the stronger secondary flow patterns observed at the higher Reynolds numbers for steady flow.     

Computational analysis of confined jet flow and mass transport in a blind tube.

A computational analysis of confined nonimpinging jet flow in a blind tube is performed as an initial investigation of the underlying fluid and mass transport mechanics of tracheal gas insufflation. A two-dimensional axisymmetric model of a laminar steady jet flow into a concentric blind-end tube is put forth and the governing continuity, momentum, and convection-diffusion equations are solved with a finite element code. The effects of the jet diameter based Reynolds number (Re(j)), the ratio of the jet-to-outer tube diameters (epsilon), and the Schmidt number (Sc) are evaluated with the determined velocity and contaminant concentration fields. The normalized penetration depth of the jet is found to increase linearly with increasing Re(j) for epsilon = O(0.1). For a given epsilon, a ring vortex that develops is observed to be displaced downstream and radially outward from the jet tip for increasing Re(j). The axial shear stress profile along the inside wall of the outer tube possesses regions of fixed shear stress in addition to a local minimum and maximum in the vicinity of the jet tip. Corresponding regions of axial shear stress gradients exist between the fixed shear stress regions and the local extrema. Contaminant concentration gradients develop across the ring vortex indicating the inward diffusion of contaminant into the jet flow. For fixed epsilon and Sc and Re(j) approximately 900, normalized contaminant flow rate is observed to be approximately twice that of simple diffusion. This model predicts modest net axial contaminant transport enhancement due to convection-diffusion interaction in the region of the ring vortex.     

Fluid flow and plaque formation in an aortic bifurcation

Considering steady laminar flow in a two-dimensional symmetric branching channel with local occlusions, a finite element model has been developed to study velocity fields including reverse flow regions, pressure profiles and wall shear stress distributions for different Reynolds numbers, bifurcation angles and lumen reductions. The flow analysis has been extended to include a new submodel for the pseudo-transient formation of plaque at sites and deposition rates defined by the physical characteristics of the flow. Specifically, simulating the onset of atherosclerotic lesions, sinusoidal plaque layers have been placed in areas of critically low wall shear stresses, and simulating the growth of particle depositions, plaque layers have been added in a stepwise fashion in regions of critically high and low shear. Thus two somewhat conflicting hypothetical correlations between critical wall shear stress levels and atheroma have been tested and a solution has been postulated. The validated computer simulation model is a predictive tool for analyzing the effects of local changes in wall curvature due to surgical reconstruction and/or atherosclerotic lesions, and for investigating the design of aortic bifurcations which mitigate plaque formation.     

Effects of vessel compliance on flow pattern in porcine epicardial right coronary arterial tree

The compliance of the vessel wall affects hemodynamic parameters which may alter the permeability of the vessel wall. Based on experimental measurements, the present study established a finite element (FE) model in the proximal elastic vessel segments of epicardial right coronary arterial (RCA) tree obtained from computed tomography. The motion of elastic vessel wall was measured by an impedance catheter and the inlet boundary condition was measured by an ultrasound flow probe. The Galerkin FE method was used to solve the Navier–Stokes and Continuity equations, where the convective term in the Navier–Stokes equation was changed in the arbitrary Lagrangian–Eulerian (ALE) framework to incorporate the motion due to vessel compliance. Various hemodynamic parameters (e.g., wall shear stress—WSS, WSS spatial gradient—WSSG, oscillatory shear index—OSI) were analyzed in the model. The motion due to vessel compliance affects the time-averaged WSSG more strongly than WSS at bifurcations. The decrease of WSSG at flow divider in elastic bifurcations, as compared to rigid bifurcations, implies that the vessel compliance decreases the permeability of vessel wall and may be atheroprotective. The model can be used to predict coronary flow pattern in subject-specific anatomy as determined by noninvasive imaging.