Effective Computational Framework for Pre-Interventional Planning of Peripheral Arteriovenous Malformations with In Vivo and In Vitro Validation

Abstract

Purpose: Peripheral arteriovenous malformations (pAVMs) are congenital lesions characterised by abnormal high-flow, low-resistance vascular connections - constituting the so-called nidus - between arteries and veins. The mainstay treatment typically involves the embolisation of the nidus with embolic and sclerosant agents, however the complexity of AVMs often leads to uncertain outcomes. This study aims at developing a simple, yet effective computational framework to aid the clinical decision making around the treatment of pAVMs. Methods: A computational model was developed to simulate the pre-, intra-, and post-intervention haemodynamics of an AVM. A porous medium of varying permeability was used to simulate the effect that the sclerosant has on the blood flow through the nidus. The computational model was informed by computed tomography (CT) scans and digital subtraction angiography (DSA) images, and the results were compared against clinical data and experimental results. Results: The computational model was able to simulate the blood flow through the AVM throughout the intervention and predict (direct and indirect) haemodynamic changes due to the embolisation. The simulated transport of the dye in the AVM was compared against DSA time-series obtained at different intervention stages, providing confidence in the results. Moreover, experimental data obtained via a mock circulatory system involving a patient specific 3D printed phantom of the same AVM provided further validation of the simulation results. Conclusion: We developed a simple computational framework to simulate AVM haemodynamics and predict the effects of the embolisation procedure. The developed model lays the foundation of a new, computationally driven treatment planning tool for AVM embolisation procedures.