Smooth muscle cell contraction increases the critical buckling pressure of arteries

Mechanical characterization and torsional buckling of pediatric cardiovascular materials

In complex cardiovascular surgical reconstructions, conduit materials that avoid possible large-scale structural deformations should be considered. A fundamental mode of mechanical complication is torsional buckling which occurs at the anastomosis site due to the mechanical instability, leading surgical conduit/patch surface deformation. The objective of this study is to investigate the torsional buckling behavior of commonly used materials and to develop a practical method for estimating the critical buckling rotation angle under physiological intramural vessel pressures. For this task, mechanical tests of four clinically approved materials, expanded polytetrafluoroethylene (ePTFE), Dacron, porcine and bovine pericardia, commonly used in pediatric cardiovascular surgeries, are conducted (n = 6). Torsional buckling initiation tests with n = 4 for the baseline case (L = 7.5 cm) and n = 3 for the validation of ePTFE (L = 15 cm) and Dacron (L = 15 cm and L = 25 cm) for each are also conducted at low venous pressures. A practical predictive formulation for the buckling potential is proposed using experimental observations and available theory. The relationship between the critical buckling rotation angle and the lumen pressure is determined by balancing the circumferential component of the compressive principal stress with the shear stress generated by the modified critical buckling torque, where the modified critical buckling torque depends linearly on the lumen pressure. While the proposed technique successfully predicted the critical rotation angle values lying within two standard deviations of the mean in the baseline case for all four materials at all lumen pressures, it could reliably predict the critical buckling rotation angles for ePTFE and Dacron samples of length 15 cm with maximum relative errors of 31% and 38%, respectively, in the validation phase. However, the validation of the performance of the technique demonstrated lower accuracy for Dacron samples of length 25 cm at higher pressure levels of 12 mmHg and 15 mmHg. Applicable to all surgical materials, this formulation enables surgeons to assess the torsional buckling potential of vascular conduits noninvasively. Bovine pericardium has been found to exhibit the highest stability, while Dacron (the lowest) and porcine pericardium have been identified as the least stable with the (unitless) torsional buckling resistance constants, 43,800, 12,300 and 14,000, respectively. There was no significant difference between ePTFE and Dacron, and between porcine and bovine pericardia. However, both porcine and bovine pericardia were found to be statistically different from ePTFE and Dacron individually (p < 0.0001). ePTFE exhibited highly nonlinear behavior across the entire strain range [0, 0.1] (or 10% elongation). The significant differences among the surgical materials reported here require special care in conduit construction and anastomosis design.

The effects of axial twisting and material non-symmetry on arterial bent buckling

Artery buckling occurs due to hypertensive lumen pressure or reduced axial tension and other pathological conditions. Since arteries in vivo often experience axial twisting and the collagen fiber alignment in the arterial wall may become nonsymmetric, it is imperative to know how axial twisting and nonsymmetric collagen alignment would affect the buckling behavior of arteries. To this end, the objective of this study was to determine the effect of axial twisting and nonsymmetric collagen fiber distribution on the critical pressure of arterial bent buckling. The buckling model analysis was generalized to incorporate an axial twist angle and nonsymmetric fiber alignment. The effect of axial twisting on the critical pressure was simulated and experimentally tested in a group of porcine carotid arteries. Our results showed that axial twisting tends to reduce the critical pressure depending on the axial stretch ratio and twist angle. In addition, nonsymmetric fiber alignment reduces the critical pressure. Experimental results confirmed that a twist angle of 90° reduces the critical pressure significantly (p < 0.05). It was concluded that axial twisting and non-axisymmetric collagen fibers distribution could make arteries prone to bent buckling. These results enrich our understanding of artery buckling and vessel tortuosity. The model analysis and results could also be applicable to other fiber reinforced tubes under lumen pressure and axial twisting.

Mechanics-driven mechanobiological mechanisms of arterial tortuosity

Arterial tortuosity manifests in many conditions, including hypertension, genetic mutations predisposing to thoracic aortopathy, and vascular aging. Despite evidence that tortuosity disrupts efficient blood flow and that it may be an important clinical biomarker, underlying mechanisms remain poorly understood but are widely appreciated to be largely biomechanical. Many previous studies suggested that tortuosity may arise via an elastic structural buckling instability, but the novel experimental-computational approach used here suggests that tortuosity arises from mechanosensitive, cell-mediated responses to local aberrations in the microstructural integrity of the arterial wall. In particular, computations informed by multimodality imaging show that aberrations in elastic fiber integrity, collagen alignment, and collagen turnover can lead to a progressive loss of structural stability that entrenches during the development of tortuosity. Interpreted in this way, microstructural defects or irregularities of the arterial wall initiate the condition and hypertension is a confounding factor.

Smooth muscle: a stiff sculptor of epithelial shapes

Smooth muscle is increasingly recognized as a key mechanical sculptor of epithelia during embryonic development. Smooth muscle is a mesenchymal tissue that surrounds the epithelia of organs including the gut, blood vessels, lungs, bladder, ureter, uterus, oviduct and epididymis. Smooth muscle is stiffer than its adjacent epithelium and often serves its morphogenetic function by physically constraining the growth of a proliferating epithelial layer. This constraint leads to mechanical instabilities and epithelial morphogenesis through buckling. Smooth muscle stiffness alone, without smooth muscle cell shortening, seems to be sufficient to drive epithelial morphogenesis. Fully understanding the development of organs that use smooth muscle stiffness as a driver of morphogenesis requires investigating how smooth muscle develops, a key aspect of which is distinguishing smooth muscle-like tissues from one another in vivo and in culture. This necessitates a comprehensive appreciation of the genetic, anatomical and functional markers that are used to distinguish the different subtypes of smooth muscle (for example, vascular versus visceral) from similar cell types (including myofibroblasts and myoepithelial cells). Here, we review how smooth muscle acts as a mechanical driver of morphogenesis and discuss ways of identifying smooth muscle, which is critical for understanding these morphogenetic events.This article is part of the Theo Murphy meeting issue 'Mechanics of Development'.

Microstructure-based constitutive model of coronary artery with active smooth muscle contraction

Currently, there is no full three-dimensional (3D) microstructural mechanical model of coronary artery based on measured microstructure including elastin, collagen and smooth muscle cells. Many structural models employ mean values of vessel microstructure, rather than continuous distributions of microstructure, to predict the mechanical properties of blood vessels. Although some models show good agreements on macroscopic vessel responses, they result in a lower elastin stiffness and earlier collagen recruitment. Hence, a full microstructural constitutive model is required for better understanding vascular biomechanics in health and disease. Here, a 3D microstructural model that accounts for all constituent microstructure is proposed to predict macroscopic and microscopic responses of coronary arteries. Coronary artery microstructural parameters were determined based on previous statistical measurements while mechanical testing of arteries (n = 5) were performed in this study to validate the computational predictions. The proposed model not only provides predictions of active and passive stress distributions of vessel wall, but also enables reliable estimations of material parameters of individual fibers and cells and thus predicts microstructural stresses. The validated microstructural model of coronary artery sheds light on vascular biomechanics and can be extend to diseased vessels for better understanding of initiation, progression and clinical treatment of vascular disease.

Microstructure-based biomechanics of coronary arteries in health and disease

Coronary atherosclerosis is the major cause of mortality and disability in developed nations. A deeper understanding of mechanical properties of coronary arteries and hence their mechanical response to stress is significant for clinical prevention and treatment. Microstructure-based models of blood vessels can provide predictions of arterial mechanical response at the macro- and micro-mechanical level for each constituent structure. Such models must be based on quantitative data of structural parameters (constituent content, orientation angle and dimension) and mechanical properties of individual adventitia and media layers of normal arteries as well as change of structural and mechanical properties of atherosclerotic arteries. The microstructural constitutive models of healthy coronary arteries consist of three major mechanical components: collagen, elastin, and smooth muscle cells, while the models of atherosclerotic arteries should account for additional constituents including intima, fibrous plaque, lipid, calcification, etc. This review surveys the literature on morphology, mechanical properties, and microstructural constitutive models of normal and atherosclerotic coronary arteries. It also provides an overview of current gaps in knowledge that must be filed in order to advance this important area of research for understanding initiation, progression and clinical treatment of vascular disease. Patient-specific structural models are highlighted to provide diagnosis, virtual planning of therapy and prognosis when realistic patient-specific geometries and material properties of diseased vessels can be acquired by advanced imaging techniques.

Artery buckling analysis using a two-layered wall model with collagen dispersion

Artery buckling has been proposed as a possible cause for artery tortuosity associated with various vascular diseases. Since microstructure of arterial wall changes with aging and diseases, it is essential to establish the relationship between microscopic wall structure and artery buckling behavior. The objective of this study was to developed arterial buckling equations to incorporate the two-layered wall structure with dispersed collagen fiber distribution. Seven porcine carotid arteries were tested for buckling to determine their critical buckling pressures at different axial stretch ratios. The mechanical properties of these intact arteries and their intima-media layer were determined via pressurized inflation test. Collagen alignment was measured from histological sections and modeled by a modified von-Mises distribution. Buckling equations were developed accordingly using microstructure-motivated strain energy function. Our results demonstrated that collagen fibers disperse around two mean orientations symmetrically to the circumferential direction (39.02°±3.04°) in the adventitia layer; while aligning closely in the circumferential direction (2.06°±3.88°) in the media layer. The microstructure based two-layered model with collagen fiber dispersion described the buckling behavior of arteries well with the model predicted critical pressures match well with the experimental measurement. Parametric studies showed that with increasing fiber dispersion parameter, the predicted critical buckling pressure increases. These results validate the microstructure-based model equations for artery buckling and set a base for further studies to predict the stability of arteries due to microstructural changes associated with vascular diseases and aging.

Buckling Reduces eNOS Production and Stimulates Extracellular Matrix Remodeling in Arteries in Organ Culture

Artery buckling alters the fluid shear stress and wall stress in the artery but its temporal effect on vascular wall remodeling is poorly understood. The purpose of this study was to investigate the early effect of artery buckling on endothelial nitric oxide synthase (eNOS) expression and extracellular matrix remodeling. Bilateral porcine carotid arteries were maintained in an ex vivo organ culture system with and without buckling while under the same physiological pressure and flow rate for 3-7 days. Matrix metalloproteinase-2 (MMP-2), MMP-9, fibronectin, elastin, collagen I, III and IV, tissue inhibitor of metalloproteinase-2 (TIMP-2), and eNOS were determined using Western blotting and immunohistochemistry. Our results showed that MMP-2 expression level was significantly higher in buckled arteries than in the controls and higher at the inner curve than at the outer curve of buckled arteries, while collagen IV content showed an opposite trend, suggesting that artery buckling increased MMP-2 expression and collagen IV degradation in a site-specific fashion. However, no differences for MMP-9, fibronectin, elastin, collagen I, III, and TIMP-2 were observed among the outer and inner curve sides of buckled arteries and straight controls. Additionally, eNOS expression was significantly decreased in buckled arteries. These results suggest that artery buckling triggers uneven wall remodeling that could lead to development of tortuous arteries.

Artery buckling analysis using a four-fiber wall model

Artery bent buckling has been suggested as a possible mechanism that leads to artery tortuosity, which is associated with aging, hypertension, atherosclerosis, and other pathological conditions. It is necessary to understand the relationship between microscopic wall structural changes and macroscopic artery buckling behavior. To this end, the objectives of this study were to develop arterial buckling equations using a microstructure-based 4-fiber reinforced wall model, and to simulate the effects of vessel wall microstructural changes on artery buckling. Our results showed that the critical pressure increased nonlinearly with the axial stretch ratio, and the 4-fiber model predicted higher critical buckling pressures than what the Fung model predicted. The buckling equation using the 4-fiber model captured the experimentally observed reduction of critical pressure induced by elastin degradation and collagen fiber orientation changes in the arterial wall. These results improve our understanding of arterial stability and its relationship to microscopic wall remodeling, and the model provides a useful tool for further studies.

An in vivo rat model of artery buckling for studying wall remodeling

Theoretical modeling and in vitro experiments have demonstrated that arterial buckling is a possible mechanism for the development of artery tortuosity. However, there has been no report of whether artery buckling develops into tortuosity, partially due to the lack of in vivo models for long-term studies. The objective of this study was to establish an in vivo buckling model in rat carotid arteries for studying arterial wall remodeling after buckling. Rat left carotid arteries were transplanted to the right carotid arteries to generate buckling under in vivo pressure and were maintained for 1 week to examine wall remodeling and adaptation. Our results showed that a significant buckling was achieved in the carotid arterial grafts with altered wall stress. Cell proliferation and matrix metalloprotinease-2 (MMP-2) expression in the buckled arteries increased significantly compared with the controls. The tortuosity level of the grafts also slightly increased 1 week post-surgery, while there was no change in vessel dimensions, blood pressure, and blood flow velocity. The artery buckling model provides a useful tool for further study of the adaptation of arteries into tortuous shapes.

Microstructural constitutive model of active coronary media

Although vascular smooth muscle cells (VSMCs) are pivotal in physiology and pathology, there is a lack of detailed morphological data on these cells. The objective of this study was to determine dimensions (width and length) and orientation of swine coronary VSMCs and to develop a microstructural constitutive model of active media. The dimensions, spatial aspect ratio and orientation angle of VSMCs measured at zero-stress state were found to follow continuous normal (or bimodal normal) distributions. The VSMCs aligned off circumferential direction of blood vessels with symmetrical polar angles 18.7° ± 10.9°, and the local VSMC deformation was affine with tissue-level deformation. A microstructure-based active constitutive model was developed to predict the biaxial vasoactivity of coronary media, based on experimental measurements of geometrical and deformation features of VSMCs. The results revealed that the axial active response of blood vessels is associated with multi-axial contraction as well as oblique VSMC arrangement. The present morphological database is essential for developing accurate structural models and is seminal for understanding the biomechanics of muscular vessels.