Hemodynamic Parameters and Early Intimal Thickening in Branching Blood Vessels.

Intimal thickening due to atherosclerotic lesions or intimal hyperplasia in medium to large blood vessels is a major contributor to heart disease, the leading cause of death in the Western World. Balloon angioplasty with stenting, bypass surgery, and endarterectomy (with or without patch reconstruction) are some of the techniques currently applied to occluded blood vessels. On the basis of the preponderance of clinical evidence that disturbed flow patterns play a key role in the onset and progression of atherosclerosis and intimal hyperplasia, it is of interest to analyze suitable hemodynamic wall parameters that indicate susceptible sites of intimal thickening and/or favorable conditions for thrombi formation.

Particle hemodynamics analysis of Miller cuff arterial anastomosis.

Objective: Studies of animal and human below-knee anastomoses with Miller cuffs indicate that improved graft patency results from redistribution of intimal hyperplasia away from areas critical to flow delivery, such as the arterial toe. We hypothesize that particle hemodynamic conditions are a biophysical mechanism potentially responsible for the clinically observed shift in intimal hyperplasia localization associated with better patency of the Miller configuration.

Methods: Computational fluid dynamics analysis of vortical flow patterns, wall shear stress fields, and potential for platelet interaction with the vascular surface was performed for realistic three-dimensional conventional and Miller cuff distal end-to-side anastomoses.

Computational analysis of effects of external carotid artery flow and occlusion on adverse carotid bifurcation hemodynamics.

Objective: This is a computational analysis of the effects of external carotid artery (ECA) flow, waveform, and occlusion geometry on two hemodynamic wall parameters associated with intimal hyperplasia and atherosclerosis. Study design Transient three-dimensional fluid mechanics analysis was applied to a standard carotid artery bifurcation. Mean internal carotid artery (ICA) flow was maintained at 236 mL/min with a normal waveform.

Long-term geometric stability of saphenous vein patched carotid endarterectomy.

Purpose: This study was designed to determine whether there is a generalized trend of progressive enlargement of the common and internal carotid bulbs after carotid endarterectomy (CEA) reconstruction with saphenous vein patches.

Methods: Twenty-nine autologous greater saphenous vein-patched CEAs performed between 1983 and 1994 were examined with five to nine sequential duplex scans each that included B-mode measurements of both the common carotid bulb (CCB) and internal carotid bulb (ICB) diameters. A total of 186 scans of each of the two segments were performed from 2 to 182 months after CEA (mean, 64 months).

Balloon catheter dilatation and thrombectomy for acute aortoiliac occlusion.

A case of acute distal aortic thrombosis in an elderly high-risk patient was successfully managed with intraoperative thrombectomy and balloon catheter dilatation of the common iliac arteries. Balloon catheter dilatation may be indicated prior to bypass grafting in high-risk patients with acute aortoiliac thrombosis.