Automated classification of peripheral distal by-pass geometries reconstructed from medical data

Geometrical methods for level set based abdominal aortic aneurysm thrombus and outer wall 2D image segmentation

Abdominal aortic aneurysm (AAA) is a localized dilatation of the aortic wall. Accurate measurements of its geometric characteristics are critical for a reliable estimate of AAA rupture risk. However, current imaging modalities do not provide sufficient contrast to distinguish thrombus from surrounding tissue thus making the task of segmentation quite challenging. The main objective of this paper is to address this problem and accurately extract the thrombus and outer wall boundaries from cross sections of a 3D AAA image data set (CTA). This is achieved by new geometrical methods applied to the boundary curves obtained by a Level Set Method (LSM). Such methods address the problem of leakage of a moving front into sectors of similar intensity and that of the presence of calcifications. The versatility of the methods is tested by creating artificial images which simulate the real cases. Segmentation quality is quantified by comparing the results with a manual segmentation of the slices of ten patient data sets. Sensitivity to the parameter settings and reproducibility are analyzed. This is the first work to our knowledge that utilizes the level set framework to extract both the thrombus and external AAA wall boundaries.

Decomposition and description of the nasal cavity form

Patient-specific studies of physiological flows rely on anatomically realistic or idealized models. Objective comparison of datasets or the relation of specific to idealized geometries has largely been performed in an ad hoc manner. Here, two rational procedures (based respectively on Fourier descriptors and medial axis (MA) transforms) are presented; each provides a compact representation of a complex anatomical region, specifically the nasal airways. The techniques are extended to furnish average geometries. These retain a sensible anatomical form, facilitating the identification of a specific anatomy as a set of weighted perturbations about the average. Both representations enable a rapid translation of the surface description into a virtual model for computation of airflow, enabling future work to comprehensively investigate the relation between anatomic form and flow-associated function, for the airways or for other complex biological conduits. The methodology based on MA transforms is shown to allow flexible geometric modeling, as illustrated by a local alteration in airway patency. Computational simulations of steady inspiratory flow are used to explore the relation between the flow in individual vs. averaged anatomical geometries. Results show characteristic flow measures of the averaged geometries to be within the range obtained from the original three subjects, irrespective of averaging procedure. However the effective regularization of anatomic form resulting from the shape averaging was found to significantly reduce trans-nasal pressure loss and the mean shear stress in the cavity. It is suggested that this may have implications in attempts to relate model geometries and flow patterns that are broadly representative.

A decoupled fluid structure approach for estimating wall stress in abdominal aortic aneurysms

Abdominal aortic aneurysm (AAA) is a localized dilatation of the aortic wall. The lack of an accurate AAA rupture risk index remains an important problem in the clinical management of the disease. To accurately estimate AAA rupture risk, detailed information on patient-specific wall stress distribution and aortic wall tissue yield stress is required. A complete fluid structure interaction (FSI) study is currently impractical and thus of limited clinical value. On the other hand, isolated static structural stress analysis based on a uniform wall loading is a widely used approach for AAA rupture risk estimation that, however, neglects the flow-induced wall stress variation. The aim of this study was to assess the merit of a decoupled fluid structure analysis of AAA wall stress. Anatomically correct, patient specific AAA wall models were created by 3D reconstruction of computed tomography images. Flow simulations were carried out with inflow and outflow boundary conditions obtained from patient extracted data. Static structural stress analysis was performed applying both a uniform pressure wall loading and a flow induced non-uniform pressure distribution obtained during early systolic deceleration. For the structural analysis, a hyperelastic arterial wall model and an elastic intraluminal thrombus model were assumed. The results of this study demonstrate that although the isolated static structural stress analysis approach captures the gross features of the stress distribution it underestimates the magnitude of the peak wall stress by as much as 12.5% compared to the proposed decoupled fluid structure approach. Furthermore, the decoupled approach provides potentially useful information on the nature of the aneurysmal sac flow.

Preliminary comparative study of small amplitude helical and conventional ePTFE arteriovenous shunts in pigs

Intimal hyperplasia (IH), which causes occlusion of arterial bypass grafts and arteriovenous (A-V) shunts, develops preferentially in low wall shear, or stagnation, regions. Arterial geometry is commonly three-dimensional, generating swirling flows, the characteristics of which include in-plane mixing and inhibition of stagnation. Clinical arterial bypass grafts are commonly two-dimensional, favouring extremes of wall shear. We have developed small amplitude helical technology (SwirlGraft) devices and shown them to generate physiological-type swirling flows. Expanded polytetrafluorethylene (ePTFE) grafts, although widely used as A-V shunts for renal dialysis access, are prone to thrombosis and IH. In a small preliminary study in pigs, we have implanted SwirlGraft ePTFE carotid artery-to-jugular vein shunts on one side and conventional ePTFE carotid artery-to-jugular vein shunts contralaterally. There was consistently less thrombosis and IH in the SwirlGraft than conventional shunts. At eight weeks (two animals), the differences were marked, with virtually no disease in the SwirlGraft devices and occlusion of the conventional grafts by thrombosis and IH. The study had limitations, but the lesser pathology in the SwirlGraft devices is likely to have resulted from their geometry and the associated swirling flow. The results could have implications for vascular biology and prolongation of the patency of arterial bypass grafts and A-V shunts.

Injection-moulded models of major and minor arteries: the variability of model wall thickness owing to casting technique

Cardiovascular disease of major and minor arteries is a common cause of death in Western society. The wall mechanics and haemodynamics within the arteries are considered to be important factors in the disease formation process. This paper is concerned with the development of an efficient computer-integrated technique to manufacture idealized and realistic models of diseased major and minor arteries from radiological images and to address the issue of model wall thickness variability. Variations in wall thickness from the original computer models to the final castings are quantified using a CCD camera. The results found that wall thickness variation from the major and minor idealized artery models to design specification were insignificant, up to a maximum of 16 per cent. In realistic models, however, differences were up to 23 per cent in the major arterial models and 58 per cent in the minor arterial models, but the wall thickness variability remained within the limits of previously reported wall thickness results. It is concluded that the described injection moulding procedure yields idealized and realistic castings suitable for use in experimental investigations, with idealized models giving better agreement with design. Wall thickness is variable and should be assessed after the models are manufactured.

Local and Global Geometric Influence on Steady Flow in Distal Anastomoses of Peripheral Bypass Grafts

We consider the effect of geometrical configuration on the steady flow field of representative geometries from an in vivo anatomical data set of end-to-side distal anastomoses constructed as part of a peripheral bypass graft. Using a geometrical classification technique, we select the anastomoses of three representative patients according to the angle between the graft and proximal host vessels (GPA) and the planarity of the anastomotic configuration. The geometries considered include two surgically tunneled grafts with shallow GPAs which are relatively planar but have different lumen characteristics, one case exhibiting a local restriction at the perianastomotic graft and proximal host whilst the other case has a relatively uniform cross section. The third case is nonplanar and characterized by a wide GPA resulting from the graft being constructed superficially from an in situ vein. In all three models the same peripheral resistance was imposed at the computational outflows of the distal and proximal host vessels and this condition, combined with the effect of the anastomotic geometry, has been observed to reasonably reproduce the in vivo flow split. By analyzing the flow fields we demonstrate how the local and global geometric characteristics influences the distribution of wall shear stress and the steady transport of fluid particles. Specifically, in vessels that have a global geometric characteristic we observe that the wall shear stress depends on large scale geometrical factors, e.g., the curvature and planarity of blood vessels. In contrast, the wall shear stress distribution and local mixing is significantly influenced by morphology and location of restrictions, particular when there is a shallow GPA. A combination of local and global effects are also possible as demonstrated in our third study of an anastomosis with a larger GPA. These relatively simple observations highlight the need to distinguish between local and global geometric influences for a given reconstruction. We further present the geometrical evolution of the anastomoses over a series of follow-up studies and observe how the lumen progresses towards the faster bulk flow of the velocity in the original geometry. This mechanism is consistent with the luminal changes in recirculation regions that experience low wall shear stress. In the shallow GPA anastomoses the proximal part of the native host vessel occludes or stenoses earlier than in the case with wide GPA. A potential contribution to this behavior is suggested by the stronger mixing that characterizes anastomoses with large GPA.