Hemodynamics in diabetic human aorta using computational fluid dynamics

Shin, Eunah; Kim, Jung-Joo; Lee, Seonjoong; Ko, Kyung Soo; Rhee, Byoung Doo; Han, Jin; Kim, Nari

doi:10.1371/journal.pone.0202671

Cited by 10 publications

(6 citation statements)

References 46 publications

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“…At baseline, blood pressure and flow patterns throughout the porcine aorta were normal and consistent with previous reports of aortic blood flow ( Vasava et al, 2012 ; Madhavan and Kemmerling, 2018 ; Shin et al, 2018 ; Deyranlou et al, 2020 ). Blood velocity profiles during hemorrhage were similar to the baseline model, albeit at a lower magnitude.…”

Section: Discussionsupporting

confidence: 89%

Development of a computational fluid dynamic model to investigate the hemodynamic impact of REBOA

Renaldo

Lane²,

Shapiro³

et al. 2022

Front. Physiol.

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Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving intervention for major truncal hemorrhage. Balloon-tipped arterial catheters are inserted via the femoral artery to create a temporary occlusion of the aorta, which minimizes the rate of internal bleeding until definitive surgery can be conducted. There is growing concern over the resultant hypoperfusion and potential damage to tissues and organs downstream of REBOA. To better understand the acute hemodynamic changes imposed by REBOA, we developed a three-dimensional computational fluid dynamic (CFD) model under normal, hemorrhage, and aortic occlusion conditions. The goal was to characterize the acute hemodynamic changes and identify regions within the aortic vascular tree susceptible to abnormal flow and shear stress.Methods: Hemodynamic data from established porcine hemorrhage models were used to build a CFD model. Swine underwent 20% controlled hemorrhage and were randomized to receive a full or partial aortic occlusion. Using CT scans, we generated a pig-specific aortic geometry and imposed physiologically relevant inlet flow and outlet pressure boundary conditions to match in vivo data. By assuming non-Newtonian fluid properties, pressure, velocity, and shear stresses were quantified over a cardiac cycle.Results: We observed a significant rise in blood pressure (∼147 mmHg) proximal to REBOA, which resulted in increased flow and shear stress within the ascending aorta. Specifically, we observed high levels of shear stress within the subclavian arteries (22.75 Pa). Alternatively, at the site of full REBOA, wall shear stress was low (0.04 ± 9.07E-4 Pa), but flow oscillations were high (oscillatory shear index of 0.31). Comparatively, partial REBOA elevated shear levels to 84.14 ± 19.50 Pa and reduced flow oscillations. Our numerical simulations were congruent within 5% of averaged porcine experimental data over a cardiac cycle.Conclusion: This CFD model is the first to our knowledge to quantify the acute hemodynamic changes imposed by REBOA. We identified areas of low shear stress near the site of occlusion and high shear stress in the subclavian arteries. Future studies are needed to determine the optimal design parameters of endovascular hemorrhage control devices that can minimize flow perturbations and areas of high shear.

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Section: Discussionsupporting

confidence: 89%

Development of a computational fluid dynamic model to investigate the hemodynamic impact of REBOA

Renaldo

Lane²,

Shapiro³

et al. 2022

Front. Physiol.

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“…Computational fluid dynamics (CFD) is widely used to simulate fluid flow which cannot be experimentally reproduced. In the fields of neurosurgery and cardiovascular surgery, CFD allows hemodynamic parameters to be assessed non-invasively as an alternative to experiments on living bodies [17][18][19][20][21]. With help from modern mathematical modeling, we believe we are able to simulate the interaction between blood and biomaterial surfaces.…”

Section: Introductionmentioning

confidence: 99%

Computational Fluid Simulation of Fibrinogen around Dental Implant Surfaces

Kitajima

Hirota

Iwai

et al. 2020

IJMS

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Ultraviolet treatment of titanium implants makes their surfaces hydrophilic and enhances osseointegration. However, the mechanism is not fully understood. This study hypothesizes that the recruitment of fibrinogen, a critical molecule for blood clot formation and wound healing, is influenced by the degrees of hydrophilicity/hydrophobicity of the implant surfaces. Computational fluid dynamics (CFD) implant models were created for fluid flow simulation. The hydrophilicity level was expressed by the contact angle between the implant surface and blood plasma, ranging from 5° (superhydrophilic), 30° (hydrophilic) to 50° and 70° (hydrophobic), and 100° (hydrorepellent). The mass of fibrinogen flowing into the implant interfacial zone (fibrinogen infiltration) increased in a time dependent manner, with a steeper slope for surfaces with greater hydrophilicity. The mass of blood plasma absorbed into the interfacial zone (blood plasma infiltration) was also promoted by the hydrophilic surfaces but it was rapid and non-time-dependent. There was no linear correlation between the fibrinogen infiltration rate and the blood plasma infiltration rate. These results suggest that hydrophilic implant surfaces promote both fibrinogen and blood plasma infiltration to their interface. However, the infiltration of the two components were not proportional, implying a selectively enhanced recruitment of fibrinogen by hydrophilic implant surfaces.

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“…[23][24][25] Furthermore, hemodynamic features of the aorta might differ between diabetic and nondiabetic patients, and computational fluid dynamic methods are currently evaluated to help understand such mechanisms. 26 Our methodology does not allow us to speculate about these mechanisms, however, as we have not assessed biomarkers. Medications used to treat DM, hyperlipidemia, and hypertension have not been definitively shown to hinder development and progression of AAA, 1 but they certainly affect long-term survival through effects on atherosclerotic manifestations.…”

Section: Discussionmentioning

confidence: 99%

Nationwide comparison of long-term survival and cardiovascular morbidity after acute aortic aneurysm repair in patients with and without type 2 diabetes

Taimour

Franzén

Zarrouk

et al. 2020

Journal of Vascular Surgery

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Objective: Epidemiologic data indicate decreased risk for development, growth, and rupture of abdominal aortic aneurysm (AAA) among patients with type 2 diabetes mellitus (DM). We therefore evaluated mortality and cardiovascular morbidity after acute repair of AAA in diabetic and nondiabetic patients. Methods: In this nationwide observational cohort study of patients registered in the Swedish Vascular Registry and the Swedish National Diabetes Register, we compared mortality and morbidity after acute open (n ¼ 1357 [61%]) or endovascular (n ¼ 860 [39%]) repair of ruptured (n ¼ 1469 [66%]) or otherwise symptomatic (n ¼ 748 [34%]) AAAs in 363 patients with and 1854 patients without DM with propensity score-adjusted analysis.Results: Follow-up was 3.91 years for patients with DM and 3.18 years for those without. In propensity-adjusted analysis, diabetic patients showed lower total mortality (relative risk [RR], 0.75; 95% confidence interval [CI], 0.59-0.95; P ¼ .016) and cardiovascular mortality (RR, 0.17; 95% CI, 0.06-0.50; P ¼ .01) than those without DM, whereas there were no differences in rates of major adverse cardiovascular events (RR, 1.10; 95% CI, 0.87-1.42; P ¼ .42), acute myocardial infarction (RR, 1.36; 95% CI, 0.70-2.63; P ¼ .37), or stroke (RR, 1.31; 95% CI, 0.84-2.03; P ¼ .23). Conclusions:Patients with type 2 DM had lower rates of both total and cardiovascular mortality after acute AAA repair than those without DM, whereas rates of cardiovascular events, acute myocardial infarction, and stroke did not differ between groups. This might be explained by putative protective effects of DM on the aortic wall. (J Vasc Surg 2020;71:30-8.)

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Hemodynamics in diabetic human aorta using computational fluid dynamics

Cited by 10 publications

References 46 publications

Development of a computational fluid dynamic model to investigate the hemodynamic impact of REBOA

Development of a computational fluid dynamic model to investigate the hemodynamic impact of REBOA

Computational Fluid Simulation of Fibrinogen around Dental Implant Surfaces

Nationwide comparison of long-term survival and cardiovascular morbidity after acute aortic aneurysm repair in patients with and without type 2 diabetes

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