Hemodynamic Characterization of Peripheral Arterio-venous Malformations

Frey, Sébastien; Haine, Axel; Kammer, Rafael Franz; Tengg-Kobligk, Hendrik von; Obrist, Dominik; Baumgartner, Iris

doi:10.1007/s10439-017-1821-9

Cited by 10 publications

(9 citation statements)

References 32 publications

(45 reference statements)

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“…Peripheral vascular anomalies are a rare disease based on a congenital disorder of vasculogenesis and angiogenesis [1,2]. They are heterogeneous in appearance and can be located in the head and neck region (40 %), the upper and lower extremities (35 %), chest and trunk (15 %) but can also become manifest in the gastrointestinal and urogenital tract (10 %) [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Sadick

Overhoff

Baeßler

et al. 2019

Fortschr Röntgenstr

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Background Peripheral vascular anomalies represent a rare disease with an underlying congenital mesenchymal and angiogenetic disorder. Vascular anomalies are subdivided into vascular tumors and vascular malformations. Both entities include characteristic features and flow dynamics. Symptoms can occur in infancy and adulthood. Vascular anomalies may be accompanied by characteristic clinical findings which facilitate disease classification. The role of periinterventional imaging is to confirm the clinically suspected diagnosis, taking into account the extent and location of the vascular anomaly for the purpose of treatment planning. Method In accordance with the International Society for the Study of Vascular Anomalies (ISSVA), vascular anomalies are mainly categorized as slow-flow and fast-flow lesions. Based on the diagnosis and flow dynamics of the vascular anomaly, the recommended periinterventional imaging is described, ranging from ultrasonography and plain radiography to dedicated ultrafast CT and MRI protocols, percutaneous phlebography and transcatheter angiography. Each vascular anomaly requires dedicated imaging. Differentiation between slow-flow and fast-flow vascular anomalies facilitates selection of the appropriate imaging modality or a combination of diagnostic tools. Results Slow-flow congenital vascular anomalies mainly include venous and lymphatic or combined malformations. Ultrasound and MRI and especially MR-venography are essential for periinterventional imaging. Arteriovenous malformations are fast-flow vascular anomalies. They should be imaged with dedicated MR protocols, especially when extensive. CT with 4D perfusion imaging as well as time-resolved 3D MR-A allow multiplanar perfusion-based assessment of the multiple arterial inflow and venous drainage vessels of arterio-venous malformations. These imaging tools should be subject to intervention planning, as they can reduce procedure time significantly. Fast-flow vascular tumors like hemangiomas should be worked up with ultrasound, including color-coded duplex sonography, MRI and transcatheter angiography in case of a therapeutic approach. In combined malformation syndromes, radiological imaging has to be adapted according to the dominant underlying vessels and their flow dynamics. Conclusion Guide to evaluation of flow dynamics in peripheral vascular anomalies, involving vascular malformations and vascular tumors with the intention to facilitate selection of periinterventional imaging modalities and diagnostic and therapeutic approach to vascular anomalies. Key Points: Citation Format

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Section: Introductionmentioning

confidence: 99%

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Sadick

Overhoff

Baeßler

et al. 2019

Fortschr Röntgenstr

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“…Baseline t d values mostly lie around 1 and AD lies between 0.4–0.8. Computations by Frey et al [ 17 ] for large scale type IIIb AVMs exhibit extremely small AD and t d values around 0.02–0.03 and 0.05–0.1, respectively. In-vivo measurements of all malformation types (circles in Fig 7 ) perfectly fit into the reported computational ranges.…”

Section: Resultsmentioning

confidence: 99%

“…Blood flow and CA transport within the microvascular networks are computed with the strategies described in our previous study on peripheral AVMs [ 17 ]. In brief, blood flow is simulated with a lumped parameter approach, where the Navier-Stokes equations [ 18 ] are averaged in space over each segment of the network (lumped element).…”

Section: Methodsmentioning

confidence: 99%

“…At the arteriolar inlet and venular outlet nodes we imposed pressure boundary conditions, which were obtained from a computational model for a physiological reference configuration [ 17 ] by probing the pressures in the pre- and post-capillary elements. The inlet pressure has a systolic/diastolic value of 60/57 mmHg, while the outlet pressure is nearly constant at approximately 13 mmHg.…”

Section: Methodsmentioning

confidence: 99%

“…CA transport is determined by solving the 1D advection-diffusion equation on the sub-divided network, based on interpolated advection velocities and a diffusion coefficient describing binary molecular diffusion of iodinated contrast agent in blood [ 17 ]. At the CA injection site (node A in , Fig 2 ), we apply a typical temporal CA injection profile sampled from DSA recordings (cf.…”

Section: Methodsmentioning

confidence: 99%

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Angioarchitecture and hemodynamics of microvascular arterio-venous malformations

et al. 2018

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IntroductionArteriovenous malformations (AVMs) are characterized by pathological high flow, low resistance connections between arteries and veins. Treatment is critically dependent on correct interpretation of angioarchitectural features. However, some microfistular AVMs do not match the characteristics described in current AVM classification systems. Therefore, we propose a new subgroup of microfistular AVMs, composed of enlarged, fistulous paths on the venous half of capillaries and/or dilated draining venules (hyperdynamic, capillary-venulous malformation [CV-AVM]). CV-AVMs still ensure arterial flow to the periphery and fistulous venous drainage is less pronounced than in classical AVMs such that these lesions are often misinterpreted as venous malformations.Materials and methodsWe developed a computational model to study the effects of microvascular anomalies on local hemodynamics, as well as their impact on angiographic contrast propagation. Flow rates and pressures were computed with a lumped parameter description, while contrast propagation was determined by solving the 1D advection-diffusion equation.Results and conclusionsFor the newly proposed CV-AVM angioarchitecture, the computational model predicts increased arterio-venous contrast agent transit times and highly dispersive transport characteristics, compared to microfistular, interstitial type IV AVMs and high flow type II and III AVMs. We related these findings to time-contrast intensity curves sampled from clinical angiographies and found that there is strong evidence for the existence of CV-AVM.

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Cardiovascular Disease: An Introduction

Thiriet

2018

Biomathematical and Biomechanical Modeling of the Circulatory and Ventilatory Systems

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Hemodynamic Characterization of Peripheral Arterio-venous Malformations

Cited by 10 publications

References 32 publications

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging

Angioarchitecture and hemodynamics of microvascular arterio-venous malformations

Cardiovascular Disease: An Introduction

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