Is there a haemodynamic advantage associated with cuffed arterial anastomoses?

Cole, Jonathan; Watterson, John; O’Reilly, M.J.G.

doi:10.1016/s0021-9290(02)00174-4

Cited by 19 publications

(14 citation statements)

References 32 publications

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“…Similar flow structures were reported by Cole et al 4 and Fisher et al 7 These hemodynamic features are believed to be inherent to the cuffed anastomoses where the vein joins the artery at a steep angle. The flow must turn sharply around the corner of the cuff toe, vacating the superior area which is filled with flow separation and reversed flow.…”

Section: Discussionsupporting

confidence: 81%

Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

Xiong

Chong

2008

Ann Biomed Eng

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Enhanced hemodynamics via geometric alteration is believed to play a role in the favorable redistribution of intimal hyperplasia (IH) in infragenicular supplementary vein cuffs. We aimed to elucidate the consequence of altering geometric configuration in anastomotic hemodynamics in cuff models. A well-validated numerical scheme was used to simulate pulsatile flows in three cuffed anastomotic models with length-to-height ratio (LHR) of 1.4, 2.2 and 3.2, and a St. Mary's boot with LHR of 2.2 at a mean flow rate of 130 mL/min. Characteristic flow patterns and wall shear stress (WSS) distributions were compared. A cohesive vortex is only present in the cuff of LHR = 1.4 and in the boot. The vortex in the cuffs becomes increasingly disorganized with increasing cuff LHR. The area of flow separation at the graft toe, prominent in the cuff of LHR = 3.2, is significantly reduced in the cuff of LHR = 1.4 and eliminated in the boot. All cuffs are characterized by flow separation, flow reversal and a sharp drop in WSS immediately distal to the cuff toe, phenomena not observed in the boot. The cuff configuration, specifically the LHR, is critical in controlling local hemodynamics. A large LHR could lead to reduced cuff performance. The study suggests the benefits of geometric optimization for reconstruction of cuffed anatomoses.

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Section: Discussionsupporting

confidence: 81%

Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

Xiong

Chong

2008

Ann Biomed Eng

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“…These secondary flow patterns may interact with other biomechanical and humoral factors to modulate suture line intimal thickening. Cole et al (2002) showed that blood flow at the distal junction of the cuffed system is characterized by expansive, low momentum recirculation within the cuff and was also associated with intimal hyperplasia. The visualization of flow patterns is very important for identifying those regions where intimal hyperplasia can develop and how these can be associated with atherosclerosis regions.…”

Section: Introductionmentioning

confidence: 99%

Flow visualization in arteriovenous fistula and aneurysm using computational fluid dynamics

Bessa

Ortiz

2009

J Vis

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The arteriovenous fistula (AVF) is characterized by enhanced blood flow and is the most widely used vascular access for chronic haemodialysis (Sivanesan et al., 1998). A large proportion of the AVF late failures are related to local haemodynamics (Sivanesan et al., 1999a).As in AVF, blood flow dynamics plays an important role in growth, rupture, and surgical treatment of aneurysm. Several techniques have been used to study the flow patterns in simplified models of vascular anastomose and aneurysm. In the present investigation, Computational Fluid Dynamics (CFD) is used to analyze the flow patterns in AVF and aneurysm through the velocity waveform obtained from experimental surgeries in dogs (Galego et al., 2000), as well as intra-operative blood flow recordings of patients with radiocephalic AVF (Sivanesan et al., 1999b) and physiological pulses (Aires, 1991), respectively. The flow patterns in AVF for dog and patient surgeries data are qualitatively similar. Perturbation, recirculation and separation zones appeared during cardiac cycle, and these were intensified in the diastole phase for the AVF and aneurysm models. The values of wall shear stress presented in this investigation of AVF and aneurysm models oscillated in the range that can both cause damage to endothelial cells and develop atherosclerosis.

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“…Different cuffed models are used such as Taylor Patch 9 and Miller Cuff Bypass 11 , but also standard end-to-side anastomoses at different graft angle 10 or other shaped carbon-fiber prostheses. For a discussion and a comparative approach see Cole et al 8,7 . In the cardiovascular system altered flow conditions such as separation, flow reversal, low and oscillatory shear stress areas and abnormal pulse pattern are all recognized as potentially important factors in the development of arterial diseases (White et al 44 , Loth et al 28 ).…”

Section: Clinical Aspects: Surgery Materials State Of the Art Problmentioning

confidence: 99%

Optimal Control and Shape Optimization of Aorto-Coronaric Bypass Anastomoses

Quarteroni

Rozza

2003

Math. Models Methods Appl. Sci.

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In this paper we present a new approach in the study of Aorto-Coronaric bypass anastomoses configurations. The theory of optimal control based on adjoint formulation is applied in order to optimize the shape of the zone of the incoming branch of the bypass (the toe) into the coronary. The aim is to provide design indications in the perspective of future development for prosthetic bypasses. With a reduced model based on Stokes equations and a vorticity functional in the down field zone of bypass, a Taylor like patch is found. A feedback procedure with Navier-Stokes fluid model is proposed based on the analysis of wall shear stress and its related indexes such as OSI.

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Is there a haemodynamic advantage associated with cuffed arterial anastomoses?

Cited by 19 publications

References 32 publications

Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

Numerical Study of the Influence of Anastomotic Configuration on Hemodynamics in Miller Cuff Models

Flow visualization in arteriovenous fistula and aneurysm using computational fluid dynamics

Optimal Control and Shape Optimization of Aorto-Coronaric Bypass Anastomoses

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