Interposition vein cuff anastomosis alters wall shear stress distribution in the recipient artery

Abstract

The vein cuff anastomosis alters the mean WSS distribution within the recipient artery and removes the area of low WSS at the heel. This may explain the redistribution of MIH away from important sites in the recipient artery.

Impact of In Vivo Ranges of the Variances in the Flow Velocity Waveforms and Flow Split Ratio on the Hemodynamic Effects of the Anastomotic Cuff at Distal End-to-Side Anastomosis

“…16 Likewise, the myointimal hyperplasia inside the anastomosis preferentially occurs at the region of low wall shear stress, including the heel, toe, and floor of the recipient artery, thus implicating an inverse relationship between the force and myointimal hyperplasia. 1,2,14,17 The results of the present study indicated that the flow behavior inside the distal anastomosis is affected by the inlet flow velocity profile and the flow split ratio. Because the reflection component of the flow velocity waveform tends to disappear with the increased numbers of ligated popliteal tributaries, there seems to be an inverse correlation between the peripheral vascular resistance and the depth of the negative reflection component.…”

“…1 A distal anastomotic cuff may improve the patency, thereby relocating or inhibiting the accretion of hyperplasia. 2,3 The mechanical properties of the cuff are not necessarily involved in such an improvement, 4 but adaptation of the flow patterns to reduce low wall shear stress areas along the recipient arterial floor has been hypothesized to be the main mechanism. 2 In recent computational fluid dynamics studies, however, conflicting views have been reported about the hemodynamic benefits.…”

“…2,3 The mechanical properties of the cuff are not necessarily involved in such an improvement, 4 but adaptation of the flow patterns to reduce low wall shear stress areas along the recipient arterial floor has been hypothesized to be the main mechanism. 2 In recent computational fluid dynamics studies, however, conflicting views have been reported about the hemodynamic benefits. 5,6 This divergence of opinions may arise from different assumptions about several important flow features in the vicinity of the anastomosis.…”

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

“…30,32,34 Others argued for the better hemodynamics produced by the unique cuff geometry. 5,9,11 They pointed out that the cuff geometry engenders a characteristic vortical flow structure which enhances mixing within the cuff to produce a wash-out effect in the cuff cavity, and reduces area of low flow and flow separation along the native artery, thereby increasing wall shear stress (WSS) at critical sites (e.g. toe, heel and floor of the host artery).…”

Why Patencies of Femoropopliteal Bypass Grafts with Distal End-to-End Anastomosis are Comparable with End-to-Side Anastomosis

“…2) The geometry of the anastomosis is an important determinant of flow patterns and WSS distribution. 3) It has been shown that the angle of an end-to-side (ETS) anastomosis can affect the local flow pattern. [4][5][6] In vitro studies have also demonstrated altered flow patterns in ETS anastomoses with a patent proximal outflow segment.…”