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Csonka D, Kalmár Nagy K, Szakály P, Szukits S, Bogner P, Koller A, Kun S, Wittmann I, Háber I, Horváth I. Optimal Renal Artery-Aorta Angulation Revealed by Flow Simulation. Kidney Blood Press Res 2023; 48:249-259. [PMID: 36940678 PMCID: PMC10173746 DOI: 10.1159/000530169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/08/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION In the circulatory system, the vessel branching angle may have hemodynamic consequences. We hypothesized that there is a hemodynamically optimal range for the renal artery's branching angle. METHODS Data on the posttransplant kinetics of estimated glomerular filtration rate (eGFR) were analyzed according to the donor and implant sides (right-to-right and left-to-right position; n = 46). The renal artery branching angle from the aorta of a randomly selected population was measured using an X-ray angiogram (n = 44). Computational fluid dynamics simulation was used to elucidate the hemodynamic effects of angulation. RESULTS AND DISCUSSION Renal transplant patients receiving a right donor kidney to the right side showed faster adaptation and higher eGFR values than those receiving a left donor kidney to the right side (eGFR: 65 ± 7 vs. 56 ± 6 mL/min/1.73 m2; p < 0.01). The average branching angle on the left side was 78° and that on the right side was 66°. Simulation results showed that the pressure, volume flow, and velocity were relatively constant between 58° and 88°, indicating that this range is optimal for the kidneys. The turbulent kinetic energy does not change significantly between 58° and 78°. CONCLUSION The results suggest that there is an optimal range for the renal artery's branching angle from the aorta where hemodynamic vulnerability caused by the degree of angulation is the lowest, which should be considered during kidney transplantations.
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Affiliation(s)
- Dávid Csonka
- Department of Mechanical Engineering, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - Károly Kalmár Nagy
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Szakály
- Department of Surgery, Medical School, University of Pécs, Pécs, Hungary
| | - Sándor Szukits
- Department of Diagnostics, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Bogner
- Department of Diagnostics, Medical School, University of Pécs, Pécs, Hungary
| | - Akos Koller
- Department of Morphology and Physiology, Faculty of Health Sciences, Budapest, Hungary
- Department of Translational Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Szilárd Kun
- 2nd Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary
| | - István Wittmann
- 2nd Department of Medicine and Nephrology-Diabetes Center, Medical School, University of Pécs, Pécs, Hungary
| | - István Háber
- Department of Mechanical Engineering, Faculty of Engineering and Information Technology, University of Pécs, Pécs, Hungary
| | - Iván Horváth
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
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Lommen MJ, Vogel JJ, VandenHull A, Reed V, Pohlson K, Answini GA, Maldonado TS, Naslund TC, Shames ML, Kelly PW. Incidence of Acute and Chronic Renal Failure Following Branched Endovascular Repair of Complex Aortic Aneurysms. Ann Vasc Surg 2021; 76:232-243. [PMID: 34182119 PMCID: PMC8595526 DOI: 10.1016/j.avsg.2021.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/02/2021] [Accepted: 04/23/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to examine the incidence of acute kidney injury and chronic renal impairment following branched endovascular aneurysm repair (BEVAR) of complex thoracoabdominal aortic aneurysms (TAAA) using the Medtronic Valiant Thoracoabdominal Aortic Aneurysm stent graft system (MVM), the physician-modified Visceral Manifold, and Unitary Manifold stent graft systems. The objective was to report the acute and chronic renal function changes in patients following complex TAAA aneurysm repair. METHODS This is an analysis of 139 patients undergoing branched endovascular repair for complex TAAAs between 2012 and 2020. Patient renal function was evaluated using serum creatinine and estimated glomerular filtration rate at baseline, 48 hr, discharge, 1 month, 6 months, and annually to 2 years. Patients on dialysis prior to the procedure were excluded from data analysis. RESULTS A total of 139 patients (mean age 71.13; 64.7% male) treated for TAAA with BEVAR met inclusion criteria and were evaluated. A total of 530 visceral vessels were stented. A majority of patients (n = 131, 94.2%) underwent a single procedure while 8 required staged procedures. Thirty-day, 1-year and 2-year all-cause mortality rates were 5.8%, 25.2%, and 32.4%, respectively. Primary and secondary patency rates at a median follow-up of 26.9 months (95% CI; 21.1 - 32.7) were 96.2% and 97.5% for all vessels and 95.4% and 96.9% for renal arteries, respectively. Postoperative acute kidney injury (AKI) was identified in 22 (15.8%) patients. At discharge, 16 patients (11.6%) had an increase in CKD stage with 3 requiring permanent dialysis. Five additional patients required permanent dialysis over the 2-year follow-up period for a total of 8 (5.8%). Increasing age (HR = 1.0327, P= 0.0477), hemoglobin < 7 prior to procedure (HR = 2.4812, P= 0.0093), increasing maximum aortic diameter (HR = 1.0189, P= 0.0084), presence of AKI (HR = 2.0757, P= 0.0182), and increase in CKD stage (HR = 1.3520, P= 0.002) at discharge were significantly associated with decreased patient survival. CONCLUSIONS Postoperative AKI and a chronic decline in renal function continue to be problematic in endovascular repair of complex aortic aneurysms. This study found that BEVAR using the manifold configuration resulted in immediate and mid-term renal function that is comparable to similar analyses of branched and/or fenestrated grafts.
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Affiliation(s)
- Matthew J Lommen
- University of South Dakota, Sanford School of Medicine, Vermillion, SD
| | - Jack J Vogel
- University of South Dakota, Sanford School of Medicine, Vermillion, SD
| | | | - Valerie Reed
- Sanford Research, Research Design and Biostatistics Core, Sioux Falls, SD
| | | | | | - Thomas S Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Thomas C Naslund
- Division of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Murray L Shames
- Division of Vascular Surgery, University of South Florida Morsani School of Medicine, Tampa, FL
| | - Patrick W Kelly
- Sanford Health, Vascular Surgery Associates, Sioux Falls, SD.
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Grégory Franck. Role of mechanical stress and neutrophils in the pathogenesis of plaque erosion. Atherosclerosis 2020; 318:60-69. [PMID: 33190807 DOI: 10.1016/j.atherosclerosis.2020.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/05/2020] [Accepted: 11/03/2020] [Indexed: 02/05/2023]
Abstract
Mechanical stress is a well-recognized driver of plaque rupture. Likewise, investigating the role of mechanical forces in plaque erosion has recently begun to provide some important insights, yet the knowledge is by far less advanced. The most significant example is that of shear stress, which has early been proposed as a possible driver for focal endothelial death and denudation. Recent findings using optical coherence tomography, computational sciences and mechanical models show that plaque erosion occurs most likely around atheromatous plaque throats with specific stress pattern. In parallel, we have recently shown that neutrophil-dependent inflammation promotes plaque erosion, possibly through a noxious action on ECs. Most importantly, spontaneous thrombosis - associated or not with EC denudation - can be impacted by hemodynamics, and it is now established that neutrophils promote thrombosis and platelet activation, highlighting a potential relationship between, mechanical stress, inflammation, and EC loss in the setting of coronary plaque erosion. Here, we review our current knowledge regarding the implication of both mechanical stress and neutrophils, and we discuss their implication in the promotion of plaque erosion via EC loss and thrombosis.
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Affiliation(s)
- Grégory Franck
- Inserm LVTS U1148. CHU Bichat, 46 Rue Henri Huchard, 75018, Paris, France.
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Zhu Y, Chen R, Juan YH, Li H, Wang J, Yu Z, Liu H. Clinical validation and assessment of aortic hemodynamics using computational fluid dynamics simulations from computed tomography angiography. Biomed Eng Online 2018; 17:53. [PMID: 29720173 PMCID: PMC5932836 DOI: 10.1186/s12938-018-0485-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 04/23/2018] [Indexed: 02/02/2023] Open
Abstract
Background Hemodynamic information including peak systolic pressure (PSP) and peak systolic velocity (PSV) carry an important role in evaluation and diagnosis of congenital heart disease (CHD). Since MDCTA cannot evaluate hemodynamic information directly, the aim of this study is to provide a noninvasive method based on a computational fluid dynamics (CFD) model, derived from multi-detector computed tomography angiography (MDCTA) raw data, to analyze the aortic hemodynamics in infants with CHD, and validate these results against echocardiography and cardiac catheter measurements. Methods This study included 25 patients (17 males, and 8 females; a median age of 2 years, range: 4 months–4 years) with CHD. All patients underwent both transthoracic echocardiography (TTE) and MDCTA within 2 weeks prior to cardiac catheterization. CFD models were created from MDCTA raw data. Boundary conditions were confirmed by lumped parameter model and transthoracic echocardiography (TTE). Peak systolic velocity derived from CFD models (PSVCFD) was compared to TTE measurements (PSVTTE), while the peak systolic pressure derived from CFD (PSPCFD) was compared to catheterization (PSPCC). Regions with low and high peak systolic wall shear stress (PSWSS) were also evaluated. Results PSVCFD and PSPCFD showed good agreements between PSVTTE (r = 0.968, p < 0.001; mean bias = − 7.68 cm/s) and PSPCC (r = 0.918, p < 0.001; mean bias = 1.405 mmHg). Regions with low and high PSWSS) can also be visualized. Skewing of velocity or helical blood flow was also observed at aortic arch in patients. Conclusions Our result demonstrated that CFD scheme based on MDCTA raw data is an accurate and convenient method in obtaining the velocity and pressure from aorta and displaying the distribution of PSWSS and flow pattern of aorta. The preliminary results from our study demonstrate the capability in combining clinical imaging data and novel CFD tools in infants with CHD and provide a noninvasive approach for diagnose of CHD such as coarctation of aorta in future.
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Affiliation(s)
- Yulei Zhu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Rui Chen
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou Chang Gung University, Taoyuan, Taiwan
| | - He Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China
| | - Jingjing Wang
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China.,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China
| | - Zhuliang Yu
- School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China. .,College of Automation Science and Technology, South China University of Technology, 381 Wushan Road, Guangzhou, 510080, Guangdong, China.
| | - Hui Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, China. .,School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China.
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Fulker D, Javadzadegan A, Li Z, Barber T. Flow visualisation study of spiral flow in the aorta-renal bifurcation. Comput Methods Biomech Biomed Engin 2017; 20:1438-1441. [PMID: 28836464 DOI: 10.1080/10255842.2017.1370460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to analyse the flow dynamics in an idealised model of the aorta-renal bifurcation using flow visualisation, with a particular focus on the effect of aorta-to-renal flow ratio and flow spirality. The recirculation length was longest when there was low flow in the renal artery and smaller in the presence of spiral flow. The results also indicate that patients without spiral flow or who have low flow in the renal artery due to the presence of stenosis may be susceptible to heightened development of atherosclerotic lesions.
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Affiliation(s)
- David Fulker
- a School of Mechanical and Manufacturing Engineering , University of New South Wales , Sydney , Australia
| | - Ashkan Javadzadegan
- b ANZAC Research Institute , The University of Sydney , Sydney , Australia.,c Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia
| | - Zuming Li
- a School of Mechanical and Manufacturing Engineering , University of New South Wales , Sydney , Australia
| | - Tracie Barber
- a School of Mechanical and Manufacturing Engineering , University of New South Wales , Sydney , Australia
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Javadzadegan A, Fulker D, Barber T. Recirculation zone length in renal artery is affected by flow spirality and renal-to-aorta flow ratio. Comput Methods Biomech Biomed Engin 2017; 20:980-990. [PMID: 28434235 DOI: 10.1080/10255842.2017.1319942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Haemodynamic perturbations such as flow recirculation zones play a key role in progression and development of renal artery stenosis, which typically originate at the aorta-renal bifurcation. The spiral nature of aortic blood flow, division of aortic blood flow in renal artery as well as the exercise conditions have been shown to alter the haemodynamics in both positive and negative ways. This study focuses on the combinative effects of spiral component of blood flow, renal-to-aorta flow ratio and the exercise conditions on the size and distribution of recirculation zones in renal branches using computational fluid dynamics technique. Our findings show that the recirculation length was longest when the renal-to-aorta flow ratio was smallest. Spiral flow and exercise conditions were found to be effective in reducing the recirculation length in particular in small renal-to-aorta flow ratios. These results support the hypothesis that in renal arteries with small flow ratios where a stenosis is already developed an artificially induced spiral flow within the aorta may decelerate the progression of stenosis and thereby help preserve kidney function.
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Affiliation(s)
- Ashkan Javadzadegan
- a Faculty of Medicine and Health Sciences , Macquarie University , Sydney , Australia.,b ANZAC Research Institute , The University of Sydney , Sydney , Australia
| | - David Fulker
- c School of Mechanical and Manufacturing Engineering, The University of New South Wales , Australia
| | - Tracie Barber
- c School of Mechanical and Manufacturing Engineering, The University of New South Wales , Australia
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Javadzadegan A, Simmons A, Barber T. Spiral blood flow in aorta-renal bifurcation models. Comput Methods Biomech Biomed Engin 2015; 19:964-76. [PMID: 26414530 DOI: 10.1080/10255842.2015.1082552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The presence of a spiral arterial blood flow pattern in humans has been widely accepted. It is believed that this spiral component of the blood flow alters arterial haemodynamics in both positive and negative ways. The purpose of this study was to determine the effect of spiral flow on haemodynamic changes in aorta-renal bifurcations. In this regard, a computational fluid dynamics analysis of pulsatile blood flow was performed in two idealised models of aorta-renal bifurcations with and without flow diverter. The results show that the spirality effect causes a substantial variation in blood velocity distribution, while causing only slight changes in fluid shear stress patterns. The dominant observed effect of spiral flow is on turbulent kinetic energy and flow recirculation zones. As spiral flow intensity increases, the rate of turbulent kinetic energy production decreases, reducing the region of potential damage to red blood cells and endothelial cells. Furthermore, the recirculation zones which form on the cranial sides of the aorta and renal artery shrink in size in the presence of spirality effect; this may lower the rate of atherosclerosis development and progression in the aorta-renal bifurcation. These results indicate that the spiral nature of blood flow has atheroprotective effects in renal arteries and should be taken into consideration in analyses of the aorta and renal arteries.
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Affiliation(s)
| | - Anne Simmons
- b School of Mechanical and Manufacturing Engineering , The University of New South Wales , Sydney , Australia
| | - Tracie Barber
- b School of Mechanical and Manufacturing Engineering , The University of New South Wales , Sydney , Australia
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