Impact of lower limb movement on the hemodynamics of femoropopliteal arteries: A computational study

Colombo, Monika; Luraghi, Giulia; Cestariolo, Ludovica; Ravasi, M; Airoldi, Anna; Chiastra, Claudio; Pennati, Giancarlo

doi:10.1016/j.medengphy.2020.05.004

Cited by 17 publications

(18 citation statements)

References 29 publications

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“…In the future, a fully personalization of the models may be achieved by considering the lower limb movement through the implementation of a recently proposed methodology. 9 In conclusion, despite the limited number of available lesions, this study gained deeper insights into ISR progression in human stented SFAs over 1Y follow-up period, disclosing the importance of long-term follow-ups in the investigation of ISR, without which information on the procedural outcomes as well as on the hemodynamic promoting factors of ISR might be lost. The present findings revealed that the lumen remodeling of human stented SFAs is a dynamic process characterized by high lumen area change during the first month post-intervention and possible focal re-narrowing in the last analyzed time interval.…”

Section: Limitations and Conclusion Remarksmentioning

confidence: 76%

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Colombo

Corti

et al. 2021

Ann Biomed Eng

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In-stent restenosis (ISR) represents a major drawback of stented superficial femoral arteries (SFAs). Motivated by the high incidence and limited knowledge of ISR onset and development in human SFAs, this study aims to (i) analyze the lumen remodeling trajectory over 1-year follow-up period in human stented SFAs and (ii) investigate the impact of altered hemodynamics on ISR initiation and progression. Ten SFA lesions were reconstructed at four follow-ups from computed tomography to quantify the lumen area change occurring within 1-year post-intervention. Patient-specific computational fluid dynamics simulations were performed at each follow-up to relate wall shear stress (WSS) based descriptors with lumen remodeling. The largest lumen remodeling was found in the first post-operative month, with slight regional-specific differences (larger inward remodeling in the fringe segments, p < 0.05). Focal re-narrowing frequently occurred after 6 months. Slight differences in the lumen area change emerged between long and short stents, and between segments upstream and downstream from stent overlapping portions, at specific time intervals. Abnormal patterns of multidirectional WSS were associated with lumen remodeling within 1-year post-intervention. This longitudinal study gave important insights into the dynamics of ISR and the impact of hemodynamics on ISR progression in human SFAs.

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Section: Limitations and Conclusion Remarksmentioning

confidence: 76%

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Colombo

Corti

et al. 2021

Ann Biomed Eng

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“…The alternate bending of the legs is known to influence the mechanical solicitation of the stent [33], the shape of the artery [34], and the local hemodynamics [9] but its role in the thrombosis onset and progression is still unknown. From our results, it is evident that leg bending increases the tortuosity Fig.…”

Section: Discussionmentioning

confidence: 99%

“…However, despite the proposed innovations, only the straight-leg configuration has been studied, thus neglecting the analysis of the effects of leg bending on the geometry and hemodynamics of the stented area. In a more recent study led by Colombo et al [9], knee flexion and complete movement of walking have been assessed in an idealized model of FPA. Finally, the impact of leg bending on geometrical and hemodynamic features have been investigated in our previous work, where patient-specific CFD simulations have been performed on a single patient, using literature boundary conditions [10] and Newtonian model for blood rheology.…”

Section: Introductionmentioning

confidence: 99%

“…According to the literature, CFD provides a useful tool for understanding and predicting disease progression and hemodynamic-related post-stent complications. However, literature studies about patient specific CFD of popliteal stenting are scarce; in particular, many of them involve idealized geometry [3,9] and literature boundary conditions [3,10], without any information regarding the follow-up intra-stent thrombosis. Moreover, morphological variations during knee flexion in the FPA could significantly influence the local hemodynamic [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Impact of leg bending in the patient-specific computational fluid dynamics of popliteal stenting

et al. 2021

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Endovascular treatment of the femoro-popliteal artery has recently become a valuable therapeutic option for popliteal arterial aneurysms. However, its efficacy remains controversial due to the relatively high rate of complications, such as stent occlusion as result of intra-stent thrombosis. The elucidation of the interplay among vessel geometrical features, local hemodynamics, and leg bending seems crucial to understand onset and progression of popliteal intra-stent thrombosis. To this aim, patient-specific computational fluid dynamic simulations were performed in order to assess the intra-stent hemodynamics of two patients endovascularly treated for popliteal arterial aneurysm by stent-grafts and experiencing intra-stent thrombosis. Both Newtonian and non-Newtonian blood rheological models were considered. Results were presented in terms of tortuosity, luminal area exposed to low (< 0.4 Pa) and high (> 1.5 Pa) time-averaged wall shear stress (TAWSS), area exposed to high (> 0.3) oscillatory shear index (OSI), and flow helicity. Study outcomes demonstrated that leg bending induced significant hemodynamic differences (> 50% increase) in both patients for all the considered variables, except for OSI in one of the two considered patients. In both leg configurations, stent-graft overlapping induced a severe discontinuity of the lumen diameter where the proximal stented zone is characterized by low tortuosity, low velocity, low helicity, low TAWSS, and high OSI; while the distal part has higher tortuosity, velocity, helicity, TAWSS, and lower OSI. Sensitivity study on applied boundary conditions showed that the different inlet velocity profiles for a given inlet waveform affect slightly the numerical solution; conversely, the shape and magnitude of the prescribed inlet waveform is determinant. Focusing on the comparison between the Newtonian and non-Newtonian blood models, the area with low TAWSS is greater in the Newtonian model for both patients, while no significant difference occurs between the surfaces with high TAWSS. GraphicAbstract Patient-specific computational fluid dynamic simulations were performed in order to assess the intra-stent hemodynamics of two patients endovascularly treated for popliteal arterial aneurysm and experiencing intra-stent thrombosis. Both Newtonian and non-Newtonian blood rheological models were considered. In both straight and bent leg configurations, stent-graft overlapping induced a severe discontinuity of the lumen diameter where the proximal stented zone is characterized by low tortuosity, low velocity, low helicity, low time-averaged wall shear stress (TAWSS), and high oscillatory index (OSI); while the distal part has higher tortuosity, velocity, helicity, TAWSS, and lower OSI.

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“…The femoropopliteal artery (FPA) is one of the most flexible arteries in the body, accommodating a range of radial, axial, and angular contortions that combine during standing, walking, and crouching movements [18, 19]. Moreover, the FPA’s dynamic biomechanics during limb flexion and its impact on hemodynamics have been implicated in the FPA’s frequent formation of atherosclerotic plaques and occlusive disease progression [18, 20]. Correspondingly, the FPA is also the most likely tissue to be afflicted by peripheral artery disease (PAD), harboring 80% of the 200 million global cases, and disease management treatments exhibit dismal long-term success rates, as low as 39% after five years [21, 22].…”

Section: Introductionmentioning

confidence: 99%

Bio-hybrid Soft Robotic Bioreactors for Mimicking Multi-Axial Femoropopliteal Artery Mechanobiology

Fell

Brooks-Richards

Woodruff

et al. 2021

Preprint

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The emerging field of soft robotics aims to emulate dynamic physiological locomotion. Soft robotics' mimicry of naturally complex biomechanics makes them ideal platforms for exerting mechanical stimuli for patient-specific tissue maturation and disease modeling applications. Such platforms are essential for emulating highly flexible tissues such as the kneecap's femoropopliteal artery (FPA), one of the most flexible arteries in the body, which flexes and bends during walking, standing, and crouching movements. The FPA is a frequent site of disease, where 80% of all peripheral artery diseases manifest, affecting over 200 million people worldwide. The complex biomechanical and hemodynamic forces within the FPA have been implicated in the frequent occurrence of PAD and lead to debilitating morbidities, such as limb-threatening ischemia. To better mimic these complex biomechanics, we developed an in-vitro bio-hybrid soft robot (BSR). First, Platsil OO-20 was identified as an ideal hyperelastomer for both cell culture and BSR fabrication using 3D printed molds. Then, employing a simulation-based design workflow, we integrated pneumatic network (PneuNet) actuators cast with Platsil OO-20, which extend in angular, longitudinal, and radial dimensions. Pressurizing the BSR PneuNets enabled a range of mechanical stimuli to be dynamically applied during tissue culture to mimic normal and diseased FPA flexions during daily walking and sitting poses, the most extreme being radial distensions of 20% and angular flexions of 140°. Finally, these designed, manufactured, and programmed vascular BSRs were seeded with mesenchymal stem cells and conditioned for 24 hours to highlight the effect of dynamic conditioning on cultured cell alignment, as well as type IV collagen production and the upregulation of smooth muscle phenotypes. Soft robotic bioreactor platforms that accurately mimic patient-, disease-, and lifestyle-specific mechanobiology will develop fundamental disease understanding, preoperative laboratory simulations for existing therapeutics, and biomanufacturing platforms for tissue-engineered implants.

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Impact of lower limb movement on the hemodynamics of femoropopliteal arteries: A computational study

Cited by 17 publications

References 29 publications

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Impact of leg bending in the patient-specific computational fluid dynamics of popliteal stenting

Bio-hybrid Soft Robotic Bioreactors for Mimicking Multi-Axial Femoropopliteal Artery Mechanobiology

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