Computational predictions of damage propagation preceding dissection of ascending thoracic aortic aneurysms

Aortic tissue stiffness and tensile strength are correlated with density changes following proteolytic treatment

INTRODUCTION

Dissection or rupture of the aorta is accompanied by high mortality rates, and there is a pressing need for better prediction of these events for improved patient management and clinical outcomes. Biomechanically, these events represent a situation wherein the locally acting wall stress exceed the local tissue strength. Based on recent reports for polymers, we hypothesized that aortic tissue failure strength and stiffness are directly associated with tissue mass density. The objective of this work was to test this novel hypothesis for porcine thoracic aorta.

METHODS

Three tissue specimens from freshly harvested porcine thoracic aorta were treated with either collagenase or elastase to selectively degrade structural proteins in the tissue, or with phosphate buffer saline (control). The tissue mass and volume of each specimen were measured before and after treatment to allow for density calculation, then mechanically tested to failure under uniaxial extension.

RESULTS

Protease treatments resulted in statistically significant tissue density reduction (sham vs. collagenase p = 0.02 and sham vs elastase p = 0.003), which in turn was significantly and directly correlated with both ultimate tensile strength (sham vs. collagenase p = 0.02 and sham vs elastase p = 0.03) and tangent modulus (sham vs. collagenase p = 0.007 and sham vs elastase p = 0.03).

CONCLUSIONS

This work demonstrates for the first time that tissue stiffness and tensile strength are directly correlated with tissue density in proteolytically-treated aorta. These findings constitute an important step towards understanding aortic tissue failure mechanisms and could potentially be leveraged for non-invasive aortic strength assessment through density measurements, which could have implications to clinical care.

Fluid-structure interaction study for biomechanics and risk factors in Stanford type A aortic dissection

Aortic dissection is a life-threatening condition with a rising prevalence in the elderly population, possibly as a consequence of the increasing population life expectancy. Untreated aortic dissection can lead to myocardial infarction, aortic branch malperfusion or occlusion, rupture, aneurysm formation and death. This study aims to assess the potential of a biomechanical model in predicting the risks of a non-dilated thoracic aorta with Stanford type A dissection. To achieve this, a fully coupled fluid-structure interaction model was developed under realistic blood flow conditions. This model of the aorta was developed by considering three-dimensional artery geometry, multiple artery layers, hyperelastic artery wall, in vivo-based physiological time-varying blood velocity profiles, and non-Newtonian blood behaviours. The results demonstrate that in a thoracic aorta with Stanford type A dissection, the wall shear stress (WSS) is significantly low in the ascending aorta and false lumen, leading to potential aortic dilation and thrombus formation. The results also reveal that the WSS is highly related to blood flow patterns. The aortic arch region near the brachiocephalic and left common carotid artery is prone to rupture, showing a good agreement with the clinical reports. The results have been translated into their potential clinical relevance by revealing the role of the stress state, WSS and flow characteristics as the main parameters affecting lesion progression, including rupture and aneurysm. The developed model can be tailored for patient-specific studies and utilised as a predictive tool to estimate aneurysm growth and initiation of wall rupture inside the human thoracic aorta.

Computational analysis of effects of clot length on Acute ischemic stroke recanalization under different cyclic aspiration loading conditions

Acute ischemic stroke, the second leading cause of death worldwide, results from occlusion of a cerebral artery by a blood clot. Application of cyclic aspiration using an aspiration catheter is a current therapy for the removal of lodged clots. In this study, we perform finite element simulations to analyze deformation of long clots, having length to radius ratio of 2-10, which corresponds to clot-length of 2.85-14.25 mm, under peak-to-peak cyclic aspiration pressures of 10-50 mmHg, and frequencies of 0.5, 1, and 2 Hz. Our computational system comprises of a nonlinear viscoelastic solid clot, a hyperelastic artery, and a nonlinear viscoelastic cohesive zone, the latter modeling the clot-artery interface. We observe that clots having length-to-radius ratio approximately greater than two separate from the inner arterial surface somewhere between the axial and distal ends, irrespective of the cyclic aspiration loading conditions. The stress distribution within the clot shows large tensile stresses in the clot interior, indicating the possibility of simultaneous fragmentation of the clot. Thus, this study shows us the various failure mechanisms simultaneously present in the clot during cyclic aspiration. Similarly, the stress distribution within the artery implies a possibility of endothelial damage to the arterial wall near the end where the aspiration pressure is applied. This framework provides a foundation for further investigation to clot fracture and adhesion characterization.

A Review on Damage and Rupture Modelling for Soft Tissues

Computational modelling of damage and rupture of non-connective and connective soft tissues due to pathological and supra-physiological mechanisms is vital in the fundamental understanding of failures. Recent advancements in soft tissue damage models play an essential role in developing artificial tissues, medical devices/implants, and surgical intervention practices. The current article reviews the recently developed damage models and rupture models that considered the microstructure of the tissues. Earlier review works presented damage and rupture separately, wherein this work reviews both damage and rupture in soft tissues. Wherein the present article provides a detailed review of various models on the damage evolution and tear in soft tissues focusing on key conceptual ideas, advantages, limitations, and challenges. Some key challenges of damage and rupture models are outlined in the article, which helps extend the present damage and rupture models to various soft tissues.

Coupling hemodynamics with mechanobiology in patient-specific computational models of ascending thoracic aortic aneurysms

BACKGROUND AND OBJECTIVE

The prevention of ascending thoracic aortic aneurysms (ATAAs), which affect thousands of persons every year worldwide, remains a major issue. ATAAs may be caused by anything that weakens the aortic wall. Altered hemodynamics, which concerns a majority of patients with bicuspid aortic valves, has been shown to be related to such weakening and to contribute to ATAA development and progression. However the underlying mechanisms remain unclear and computational modeling in this field could help significantly to elucidate how hemodynamics and mechanobiology interact in ATAAs.

METHODS

Accordingly, we propose a numerical framework combining computational fluid dynamics and 4D flow magnetic resonance imaging (MRI) coupled with finite element (FE) analyses to simulate growth and remodeling (G&R) occurring in patient-specific aortas in relation with altered hemodynamics. The geometries and the blood velocities obtained from 4D flow MRI are used as boundary conditions for CFD simulations. CFD simulations provide an estimation of the wall shear stress (WSS) and relative residence time (RRT) distribution across the luminal surface of the wall. An initial insult is then applied to the FE model of the aortic wall, assuming that the magnitude of the insult correlates spatially with the normalized RRT distribution obtained from CFD simulations. G&R simulations are then performed. The material behavior of each Gauss point in these FE models is evolved continuously to compensate for the deviation of the actual wall stress distribution from the homeostatic state after the initial insult. The whole approach is illustrated on two healthy and two diseased subjects. The G&R parameters are calibrated against previously established statistical models of ATAA growth rates.

RESULTS

Among the variety of results provided by G&R simulations, the analysis focused especially on the evolution of the wall stiffness, which was shown to be a major risk factor for ATAAs. It was shown that the G&R parameters, such as for instance the rate of collagen production or cell mechanosensitivity, play a critical role in ATAA progression and remodeling.

CONCLUSIONS

These preliminary findings show that patient-specific computational modeling coupling hemodynamics with mechanobiology is a promising approach to explore aneurysm progression.

Sensitivity analysis of non-local damage in soft biological tissues

Computational modeling can provide insight into understanding the damage mechanisms of soft biological tissues. Our gradient-enhanced damage model presented in a previous publication has shown advantages in considering the internal length scales and in satisfying mesh independence for simulating damage, growth and remodeling processes. Performing sensitivity analyses for this model is an essential step towards applications involving uncertain patient-specific data. In this paper, a numerical analysis approach is developed. For that we integrate two existing methods, that is, the gradient-enhanced damage model and the surrogate model-based probability analysis. To increase the computational efficiency of the Monte Carlo method in uncertainty propagation for the nonlinear hyperelastic damage analysis, the surrogate model based on Legendre polynomial series is employed to replace the direct FEM solutions, and the sparse grid collocation method (SGCM) is adopted for setting the collocation points to further reduce the computational cost in training the surrogate model. The effectiveness of the proposed approach is illustrated by two numerical examples, including an application of artery dilatation mimicking to the clinical problem of balloon angioplasty.

A Parametric Study on Factors Influencing the Onset and Propagation of Aortic Dissection Using the Extended Finite Element Method

OBJECTIVE

Aortic dissection is a life-threatening event which starts most of the time with an intimal tear propagating along the aortic wall, while blood enters the medial layer and delaminates the medial lamellar units. Studies investigating the mechanisms underlying the initiation sequence of aortic dissection are rare in the literature, the majority of studies being focused on the propagation event. Numerical models can provide a deeper understanding of the phenomena involved during the initiation and the propagation of the initial tear, and how geometrical and mechanical parameters affect this event. In the present paper, we investigated the primary factors contributing to aortic dissection.

METHODS

A two-layer arterial model with an initial tear was developed, representing three different possible configurations depending on the initial direction of the tear. Anisotropic damage initiation criteria were developed based on uniaxial and shear experiments from the literature to predict the onset and the direction of crack propagation. We used the XFEM-based cohesive segment method to model the initiation and the early propagation of the tear along the aorta. A design of experiment was used to quantify the influence of 7 parameters reflecting crack geometry and mechanics of the wall on the critical pressure triggering the dissection and the directions of propagation of the tear.

RESULTS

The results showed that the obtained critical pressures (mean range from 206 to 251 mmHg) are in line with measurement from the literature. The medial tensile strength was found to be the most influential factor, suggesting that a medial degeneration is needed to reach a physiological critical pressure and to propagate a tear in an aortic dissection. The geometry of the tear and its location inside the aortic wall were also found to have an important role not only in the triggering of tear propagation, but also in the evolution of the tear into either aortic rupture or aortic dissection. A larger and deeper initial tear increases the risk of aortic dissection.

CONCLUSION

The numerical model was able to reproduce the behaviour of the aorta during the initiation and propagation of an aortic dissection. In addition to confirm multiple results from the literature, different types of tears were compared and the influence of several geometrical and mechanical parameters on the critical pressure and direction of propagation was evaluated with a parametric study for each tear configuration.

SIGNIFICANCE

Although these results should be experimentally validated, they allow a better understanding of the phenomena behind aortic dissection and can help in improving the diagnosis and treatment of this disease.

Computational Study of Growth and Remodeling in Ascending Thoracic Aortic Aneurysms Considering Variations of Smooth Muscle Cell Basal Tone

In this paper, we investigate the progression of Ascending Thoracic Aortic Aneurysms (ATAA) using a computational model of Growth and Remodeling (G&R) taking into account the composite (elastin, four collagen fiber families and Smooth Muscle Cells—SMCs) and multi-layered (media and adventitia) nature of the aorta. The G&R model, which is based on the homogenized Constrained Mixture theory, is implemented as a UMAT in the Abaqus finite-element package. Each component of the mixture is assigned a strain energy density function: nearly-incompressible neo-Hookean for elastin and Fung-type for collagen and SMCs. Active SMCs tension is additionally considered, through a length-tension relationship having a classic inverted parabola shape, in order to investigate its effects on the progression of ATAA in a patient-specific model. A sensitivity analysis is performed to evaluate the potential impact of variations in the parameters of the length-tension relationships. These variations reflect in variations of SMCs normal tone during ATAA progression, with active stress contributions ranging between 30% (best case scenario) and 0% (worst case scenario) of the total wall circumferential stress. Low SMCs active stress in the worst case scenarios, in fact, affect the rates of collagen deposition by which the elastin loss is gradually compensated by collagen deposition in the simulated ATAA progression, resulting eventually in larger aneurysm diameters. The types of length-tension relationships leading to a drop of SMCs active stress in our simulations reveal a critical condition which could also result in SMCs apoptosis.

In vitro histomechanical effects of enzymatic degradation in carotid arteries during inflation tests with pulsatile loading

In this paper, the objective is to assess the histomechanical effects of collagen proteolysis in arteries under loading conditions reproducing in vivo environment. Thirteen segments of common porcine carotid arteries (8 proximal and 5 distal) were immersed in a bath of bacterial collagenase and tested with a pulsatile tension/inflation machine. Diameter, pressure and axial load were monitored throughout the tests and used to derive the stress-stretch curves and to determine the secant circumferential stiffness. Results were analysed separately for proximal and distal segments, before and after 1, 2 and 3 h of enzymatic degradation. A histological analysis was performed to relate the arterial microstructure to its mechanical behavior under collagen proteolysis. Control (before enzymatic degradation) and treated populations (after 1, 2 or 3 h of enzymatic degradation) were found statistically incomparable, and histology confirmed the alteration of the fibrous structure of collagen bundles induced by the collagenase treatment. A decrease of the secant circumferential stiffness of the arterial wall was noticed mostly at the beginning of the treatment, and was less pronounced after 1 h. These results constitute an important set of enzymatically damaged arteries that can be used to validate biomechanical computational models correlating structure and properties of blood vessels.

Three-dimensional numerical simulation of soft-tissue wound healing using constrained-mixture anisotropic hyperelasticity and gradient-enhanced damage mechanics

Healing of soft biological tissues is the process of self-recovery or self-repair after injury or damage to the extracellular matrix (ECM). In this work, we assume that healing is a stress-driven process, which works at recovering a homeostatic stress metric in the tissue by replacing the damaged ECM with a new undamaged one. For that, a gradient-enhanced continuum healing model is developed for three-dimensional anisotropic tissues using the modified anisotropic Holzapfel-Gasser-Ogden constitutive model. An adaptive stress-driven approach is proposed for the deposition of new collagen fibres during healing with orientations assigned depending on the principal stress direction. The intrinsic length scales of soft tissues are considered through the gradient-enhanced term, and growth and remodelling are simulated by a constrained-mixture model with temporal homogenization. The proposed model is implemented in the finite-element package Abaqus by means of a user subroutine UEL. Three numerical examples have been achieved to illustrate the performance of the proposed model in simulating the healing process with various damage situations, converging towards stress homeostasis. The orientations of newly deposited collagen fibres and the sensitivity to intrinsic length scales are studied through these examples, showing that both have a significant impact on temporal evolutions of the stress distribution and on the size of the damage region. Applications of the approach to carry out in silico experiments of wound healing are promising and show good agreement with existing experiment results.

A new finite-element shell model for arterial growth and remodeling after stent implantation

The goal of this paper is to study computationally how blood vessels adapt when they are exposed to a mechanobiological insult, namely, a sudden change of their biomechanical conditions such as proteolytic injuries or implantation. Adaptation occurs through growth and remodeling (G&R), consisting of mass production or removal of structural proteins, such as collagen, until restoring the initial homeostatic biomechanical conditions. In some circumstances, the initial conditions can never be recovered, and arteries evolve towards unstable pathological conditions, such as aneurysms, which are responsible for significant morbidity and mortality. Therefore, computational predictions of G&R under different circumstances can be helpful in understanding fundamentally how arterial pathologies progress. For that, we have developed a low-cost open-source finite-element 2D axisymmetric shell model (FEM) of the arterial wall. The constitutive equations for static equilibrium used to model the stress-strain behavior and the G&R response are expressed within the homogenized constrained mixture theory. The originality is to integrate the layer-specific behavior of both arterial layers (media and adventitia) into the model. Considering different mechanobiological insults, our results show that the resulting arterial dilatation is strongly correlated with the media thickness. The adaptation to stent implantation is particularly interesting. For large stent oversizing ratios, the artery cannot recover from the mechanobiological insult and dilates forever, whereas dilatation stabilizes after a transient period for more moderate oversizing ratios. We also show that stent implantation induces a different response in an aneurysm or in a healthy artery, the latter yielding more unstable G&R. Finally, our G&R model can efficiently predict, with very low computational cost, fundamental aspects of arterial adaptation induced by clinical procedures.

Modeling lamellar disruption within the aortic wall using a particle-based approach

Aortic dissections associate with medial degeneration, thus suggesting a need to understand better the biophysical interactions between the cells and matrix that constitute the middle layer of the aortic wall. Here, we use a recently extended "Smoothed Particle Hydrodynamics" formulation to examine potential mechanisms of aortic delamination arising from smooth muscle cell (SMC) dysfunction or apoptosis, degradation of or damage to elastic fibers, and pooling of glycosaminoglycans (GAGs), with associated losses of medial collagen in the region of the GAGs. First, we develop a baseline multi-layered model for the healthy aorta that delineates medial elastic lamellae and intra-lamellar constituents. Next, we examine stress fields resulting from the disruption of individual elastic lamellae, lost SMC contractility, and GAG production within an intra-lamellar space, focusing on the radial transferal of loading rather than on stresses at the tip of the delaminated tissue. Results suggest that local disruptions of elastic lamellae transfer excessive loads to nearby intra-lamellar constituents, which increases cellular vulnerability to dysfunction or death. Similarly, lost SMC function and accumulations of GAGs increase mechanical stress on nearby elastic lamellae, thereby increasing the chance of disruption. Overall these results suggest a positive feedback loop between lamellar disruption and cellular dropout with GAG production and lost medial collagen that is more pronounced at higher distending pressures. Independent of the initiating event, this feedback loop can catastrophically propagate intramural delamination.

Gradient-enhanced continuum models of healing in damaged soft tissues

Healing of soft biological tissue is the process of self-recovering or self-repairing the injured or damaged extracellular matrix (ECM). Healing is assumed to be stress-driven, with the objective of returning to a homeostatic stress metrics in the tissue after replacing the damaged ECM with new undamaged one. However, based on the existence of intrinsic length scales in soft tissues, it is thought that computational models of healing should be non-local. In the present study, we introduce for the first time two gradient-enhanced constitutive healing models for soft tissues including non-local variables. The first model combines a continuum damage model with a temporally homogenized growth model, where the growth direction is determined according to local principal stress directions. The second one is based on a gradient-enhanced healing model with continuously recoverable damage variable. Both models are implemented in the finite-element package Abaqus by means of a user subroutine UEL. Three two-dimensional situations simulating the healing process of soft tissues are modeled numerically with both models, and their application for simulation of balloon angioplasty is provided by illustrating the change of damage field and geometry in the media layer throughout the healing process.