The Anastomosis Angle Is a Key to Improved Long-Term Patency of Proximal Femoropopliteal Bypass

Grus, Tomáš; Lindner, Jaroslav; Vidim, T; Tosovský, J; Matěcha, J.; Rohn, Vilém; Lambert, Lukáš; Grusová, Gabriela

doi:10.1016/j.avsg.2009.06.008

Cited by 18 publications

(27 citation statements)

References 29 publications

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“…The collateral artery is of 3 mm in diameter and has been positioned perpendicular to the main artery, which is quite common for bifurcations of this artery. During surgery, the inclination angle between the graft and main artery is hard to control, but it is recommended to maintain at 30° or even lower . The angle of inclination has not been investigated in this study and is at 30° for all geometries.…”

Section: Methodsmentioning

confidence: 99%

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A computational fluid dynamics study on hemodynamics for different locations of the distal anastomosis of a bypass nearby a collateral vessel in the femoropopliteal area

Rivera

Graaf

Escudero

et al. 2014

Numer Methods Biomed Eng

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Revascularization of the femoropopliteal sector is often performed by the placement of a bypass. In this paper, we have studied the effects of hemodynamics on patency of the bypass for different positions of the distal anastomosis close to a collateral artery. Computational fluid dynamics (CFD) are used for this study. The cardiac cycle-averaged wall shear stress (WSS) and oscillation index (OSI) have been analyzed. Low WSS and high OSI may increase the risk of intimal hyperplasia (IH), which may reduce bypass patency. From the CFD simulations, spots of low WSS and high OSI are found within and near the entrance of the collateral artery, near the suture line, at the floor, toe, and heel. We regarded flow ratios of 20:80 and of 35:65. It is found that for the high flow ratio anastomosis located proximal to the collateral artery is clearly more advantageous. However for the low flow ratio anastomosis located distal to the collateral artery seems to be slightly more advantageous, the results are less conclusive. One of the studied flow geometries has been validated by in vitro experiments using a time resolved particle image velocimetry technique. Velocity fields from these experiments are in good agreement with the CFD results.

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Section: Methodsmentioning

confidence: 99%

“…Hemodynamics has been found to play an important role in bypass patency . In recent years, computational fluid dynamics ( CFD ) has become an important tool for understanding the relevant hemodynamic features.…”

Section: Introductionmentioning

confidence: 99%

A computational fluid dynamics study on hemodynamics for different locations of the distal anastomosis of a bypass nearby a collateral vessel in the femoropopliteal area

Rivera

Graaf

Escudero

et al. 2014

Numer Methods Biomed Eng

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“…Formation of intimal hyperplasia in distal endto-side anastomosis of a femoropopliteal bypass has been described in numerous studies (Grus et al 2009, McGah et al 2012, Zilla et al 2012. Intimal hyperplasia which is the main cause of graft failure within the first postoperative year is a complex phenomenon (Dolmatch et al 2007).…”

Section: Vol 67mentioning

confidence: 96%

“…Intimal hyperplasia which is the main cause of graft failure within the first postoperative year is a complex phenomenon (Dolmatch et al 2007). Disturbed hemodynamics in the anastomosis especially too low or high wall shear stress has been identified to promote its formation (Grus et al 2009, Grus et al 2016a, Subbotin 2007. Based on clinical and simulation studies, several improvements addressing hemodynamics, including construction of an acute anastomosis angle, have been proposed (Bellosta et al 2013, Grus et al 2016a, Grus et al 2016b.…”

Section: Vol 67mentioning

confidence: 99%

Natural Remodeling of the Distal Anastomosis of an Above-Knee Femoropopliteal Bypass Depicted by CT Angiography of Lower Limbs Improves Geometry of the Reconstruction

Grusová

Lambert

Kaván³

et al. 2018

Physiol Res

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The geometry of the distal anastomosis of a femoropopliteal bypass influences local hemodynamics and formation of intimal hyperplasia. We hypothesized that the distal anastomosis of an above-knee femoropopliteal bypass undergoes remodeling that results in displacement of the original course of the popliteal artery and change in the anastomosis angle. We identified 43 CT angiography examination with proximal femoropopliteal bypass and either a preserved contralateral popliteal artery or previous CTA before construction of the bypass for comparison. In these examinations, we measured the displacement distance and angle at the level of the distal anastomosis and compared these measurements with clinical and imaging data. The displacement distance was 8.8±4.9 mm (P<0.0001) and the displacement angle was -1° (IQR=44°). The angle between the inflow and outflow artery was 153±16° (P<0.0001). There was a negative association between the displacement angle and the angle between the bypass and the outflow artery (r=-0.318, P=0.037).Patients with reversed venous grafts had a greater displacement of the anastomosis (14.7±3.0 mm) than patients with prosthetic grafts (8.0±4.5 mm, P=0.0011). We conclude that construction of a distal anastomosis of proximal femoropopliteal bypass results in displacement of the original course of the popliteal artery towards the bypass and this effect is more pronounced in reversed venous grafts.

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“…for mass or heat transfer in various solar systems [1], heat exchangers [2], blade machines, fuel cells [3,4] etc. The issue of unsteady phenomena is also reflected in areas, which seem to be distant from engineering practice at first sight, such us blood flow in cardiovascular system [5,6,7,8,9] or air flow in the respiratory system [10].…”

Section: Introductionmentioning

confidence: 99%

Method for the evaluation of minor losses in pulsatile laminar fluid flow

Netřebská

Matěcha

Schmirler

et al. 2014

EPJ Web of Conferences

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Abstract. This article focuses on description and evaluation of the size of the minor losses in pulsatile laminar flow. It describes a method for determination of minor losses with respect to the phase delay between pressure waveforms and flow waveforms. The whole evaluation method is presented on the example of minor loss in the sharp 90° bend in the channel with constant square cross-section in pulsatile laminar flow of an incompressible Newtonian fluid. For this example, the minor loss coefficient is expressed depending on the dimensionless flow parameters. Total minor loss was calculated numerically. An analytical solution was used for quantification of the head loss in the developed laminar flow in the straight channel. Unsteady flow conditions were controlled by the sinusoidal flow.

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The Anastomosis Angle Is a Key to Improved Long-Term Patency of Proximal Femoropopliteal Bypass

Cited by 18 publications

References 29 publications

A computational fluid dynamics study on hemodynamics for different locations of the distal anastomosis of a bypass nearby a collateral vessel in the femoropopliteal area

A computational fluid dynamics study on hemodynamics for different locations of the distal anastomosis of a bypass nearby a collateral vessel in the femoropopliteal area

Natural Remodeling of the Distal Anastomosis of an Above-Knee Femoropopliteal Bypass Depicted by CT Angiography of Lower Limbs Improves Geometry of the Reconstruction

Method for the evaluation of minor losses in pulsatile laminar fluid flow

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