Non-invasive Stenotic Renal Artery Haemodynamics by in silico Medicine

Mandaltsi, Aikaterini; Grytsan, Andrii; Odudu, Aghogho; Kądziela, Jacek; Morris, Paul D; Witkowski, Adam; Ellam, Timothy; Kalra, Philip A.; Marzo, Alberto

doi:10.3389/fphys.2018.01106

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…Numerical simulation of the flow in renal arteries and its relation to renal artery stenosis (RAS) was recently reported [11,12]. In the present study, four indicators are considered in order to assess the possibility of relapse of atherosclerosis/stenosis after revascularization.…”

Section: Introductionmentioning

confidence: 99%

Stenosis Indicators Applied to Patient-Specific Renal Arteries without and with Stenosis

Fuchs

Berg

Wittberg

2019

Fluids

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Pulsatile flow in the abdominal aorta and the renal arteries of three patients was studied numerically. Two of the patients had renal artery stenosis. The aim of the study was to assess the use of four types of indicators for determining the risk of new stenosis after revascularization of the affected arteries. The four indicators considered include the time averaged wall shear stress (TAWSS), the oscillatory shear index (OSI), the relative reference time (RRT) and a power law model based in platelet activation modeling but applied to the endothelium, named endothelium activation indicator (EAI). The results show that the indicators can detect the existing stenosis but are less successful in the revascularized cases. The TAWSS and, more clearly, the EAI approach seem to be better in predicting the risk for stenosis relapse at the original location and close to the post-stenotic dilatation. The shortcomings of the respective indicators are discussed along with potential improvements to endothelial activation modeling and its use as an indicator for risks of restenosis.

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Section: Introductionmentioning

confidence: 99%

Stenosis Indicators Applied to Patient-Specific Renal Arteries without and with Stenosis

Fuchs

Berg

Wittberg

2019

Fluids

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“…The application of computational FFR, sometimes referred as Pd/Pa in this context, was attempted almost 2 decades ago based on CFD and contrast-enhanced MR images 53 , which is even less invasive compared to the CT-based techniques. More recent attempts using CT images have successfully demonstrated a good quantitative agreement of Pd/Pa values between computational prediction and invasive measurement ( Figure 4 ) 54 .…”

Section: Challenges and New Application Areasmentioning

confidence: 80%

“…CT-based analysis requires an additional measurement or model to obtain inflow condition. A 1-dimensional model of systemic circulation was used by Mandaltsi et al 54 .…”

Section: Challenges and New Application Areasmentioning

confidence: 99%

CT-based fractional flow reserve: development and expanded application

Torii

Yacoub

2021

gcsp

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Computations of fractional flow reserve, based on CT coronary angiography and computational fluid dynamics (CT-based FFR) to assess the severity of coronary artery stenosis, was introduced around a decade ago and is now one of the most successful applications of computational fluid dynamic modelling in clinical practice. Although the mathematical modelling framework behind this approach and the clinical operational model vary, its clinical efficacy has been demonstrated well in general. In this review, technical elements behind CT-based FFR computation are summarised with some key assumptions and challenges. Examples of these challenges include the complexity of the model (such as blood viscosity and vessel wall compliance modelling), whose impact has been debated in the research. Efforts made to address the practical challenge of processing time are also reviewed. Then, further application areas – myocardial bridge, renal stenosis and lower limb stenosis – are discussed along with specific challenges expected in these areas.

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“…FMD affects 0.4% of the population and is seen in younger patients .Reduced renal perfusion causes progressive chronic kidney disease (CKD) and drives neurohormonal activation with subsequent resistant hypertension, end-stage kidney disease, and death. (16) In the present study, we aimed to evaluate the diagnosis and indications of surgical treatment of renovascular hypertension.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of renovascular hypertension

Salem

et al. 2020

Zagazig University Medical Journal

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Background: Renovascular hypertension is the commonest form of secondary hypertension. It occurs in less than 5 % of all hypertensive population. There are two forms of renovascular hypertension: Atherosclerotic and fibromuscular dysplasia. Renovascular hypertension is suspected when it develops suddenly in patients under 30 or over 55 years of age, or abruptly worsen in any patient. The aim was to evaluate the indications of surgical treatment of "renovascular hypertension". Methods: Twenty cases with renovascular hypertension were included. The main investigations were: Laboratory studies, Duplex ultrasound, Intravenous pyelogram, CT angiography, aortography and selective renal angiography. Indications for surgery were : complex disease of the renal artery, aneurysm, accessory renal arteries, fibromuscular dysplasia and partial damaged of one kidney. Also, atherosclerotic stenosis of the renal arteries and complete kidney damage. Results : According to the etiology, 20 patients were divided into two groups : Group 1(Below 30 years)(Fibromuscular dysplasia group)which included 14 patients, (100.0%) were females, their age ranged from 18 to years with the mean±SD (24.7±3.5).Group 2(Above55 years)(Atherosclerotic group) which included 6 patients, their age ranged from 55 to 68 years with the mean±SD(62 ±4.1), 5(83.3%)were males and 1(16.7%) was female. Renal artery bypass graft was done for 15 cases, endarterectomy in 2 cases, endarterectomy with patch graft in two cases and nephrectomy in one case. Control of hypertension was successful in 17 cases, partial control of 2 cases, while the blood pressure still high in case of nephrectomy. No mortality in both groups within 6 months follow up period. Conclusions : Surgical treatment for renovascular hypertension is mandatory for complex disease of the renal artery, aneurysms and failure of endovascular procedures. Nephrectomy is the treatment of choice for damaged kidney.

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Non-invasive Stenotic Renal Artery Haemodynamics by in silico Medicine

Cited by 7 publications

References 36 publications

Stenosis Indicators Applied to Patient-Specific Renal Arteries without and with Stenosis

Stenosis Indicators Applied to Patient-Specific Renal Arteries without and with Stenosis

CT-based fractional flow reserve: development and expanded application

Surgical treatment of renovascular hypertension

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