The Influence of the Anastomosis Angle on the Hemodynamics in the Distal Anastomosis in the Infrainguinal Bypass: an In Vitro Study

Abstract

The geometric shape of the distal anastomosis in an infrainguinal bypass has an influence on its durability. In this article, we compared three different angles of the anastomosis with regard to the hemodynamics. Three experimental models of the distal infrainguinal anastomosis with angles of 25°, 45°, and 60° respectively were constructed according to the similarity theory to assess flow in the anastomoses using particle image velocimetry and computational fluid dynamics. In the toe, heel, and floor of the anastomosis that correspond to the locations worst affected by intimal hyperplasia, adverse blood flow and wall shear stress were observed in the 45° and 60° models. In the 25° model, laminar blood flow was apparent more peripherally from the anastomosis. In conclusions, decreasing the distal anastomosis angle in a femoropopliteal bypass results in more favorable hemodynamics including the flow pattern and wall shear stress in locations susceptible to intimal hyperplasia.

Multi-Scale, Patient-Specific Computational Flow Dynamics Models Predict Formation of Neointimal Hyperplasia in Saphenous Vein Grafts

“…23 Much less research has been reported on mechanisms of failure of peripheral bypasses, with most reported work focused on design optimization. 24 This preliminary study of 3 patients couples CFD analyses with a model of smooth muscle cells and collagen turnover, including growth factor and NO production. 7 The results show a change from an initial, predominantly homogeneous distribution of smooth muscle cells and collagen at day 146 to a localized area of growth corresponding to areas in which the graft experienced low shear and oscillations ( Supplementary Figure 4 and 5).…”

The effect of angle between the graft and coronary artery on volumetric flow rate through the anastomosis

“…Ghista, указывает, что меньший угол ( 30°) вшивания шунта приводит к меньшим колебаниям кровотока и более плавному потоку крови из шунта в коронарную артерию [7]. Подобные результаты получил T. Grus на компьютерных моделях анастомозов, подтверждая меньшую вероятность развития ИГ при малых углах между сосудами [11]. И.М.…”

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

“…The natural remodeling of the anastomosis decreases the anastomosis angle and therefore improves hemodynamics in the reconstruction, promotes laminar flow and improves hemodynamic parameters known to induce neointimal hyperplasia (Grus et al 2009, Grus et al 2016a, Grus et al 2016b.…”

“…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.…”