Effect of anticoagulant treatment in deep vein thrombosis: A patient-specific computational fluid dynamics study

Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling

Venous thromboembolism (VTE) is a massive clinical challenge, annually affecting millions of patients globally. VTE is a particularly consequential pathology, as incidence is correlated with extremely common risk factors, and a large cohort of patients experience recurrent VTE after initial intervention. Altered hemodynamics, hypercoagulability, and damaged vascular tissue cause deep-vein thrombosis and pulmonary embolism, the two permutations of VTE. Venous valves have been identified as likely locations for initial blood clot formation, but the exact pathway by which thrombosis occurs in this environment is not entirely clear. Several risk factors are known to increase the likelihood of VTE, particularly those that increase inflammation and coagulability, increase venous resistance, and damage the endothelial lining. While these risk factors are useful as predictive tools, VTE diagnosis prior to presentation of outward symptoms is difficult, chiefly due to challenges in successfully imaging deep-vein thrombi. Clinically, VTE can be managed by anticoagulants or mechanical intervention. Recently, direct oral anticoagulants and catheter-directed thrombolysis have emerged as leading tools in resolution of venous thrombosis. While a satisfactory VTE model has yet to be developed, recent strides have been made in advancing in silico models of venous hemodynamics, hemorheology, fluid-structure interaction, and clot growth. These models are often guided by imaging-informed boundary conditions or inspired by benchtop animal models. These gaps in knowledge are critical targets to address necessary improvements in prediction and diagnosis, clinical management, and VTE experimental and computational models.

Microneedle patch-assisted transdermal administration of recombinant hirudin for the treatment of thrombotic diseases

The painless microneedle patch (MNP), widely explored for transdermal drug delivery of macromolecules, can overcome the limitations of traditional administrations of protein and polypeptide anticoagulant drugs. We constructed a recombinant hirudin-loaded microneedle patch, suitable for patients with thrombotic diseases requiring long-term preventive medication. The recombinant hirudin-loaded dissoluble microneedle patch (RHDMNP) was created using a mold casting technique and polyvinylpyrrolidone and polyvinyl alcohol were used as the matrix material with a 1:1.2 ratio. We prepared bilayer RHDMNPs with pyramidal appearance and 0.37 N/needle strength. The intradermal dissolution height of the microneedle reached approximately 78.67% of the total height, and 68.12% of the drug was delivered into the skin. The 12-hour cumulative permeation of the MNP was 21.69 ± 3.90 μg/cm². The MNP showed a T_max of 1.5 h, C_max of 144 ± 71 ng/mL, and area under curve (AUC) of 495 ± 66 ng/mL·min compared to T_max of 0.5 h, C_max of 249 ± 89 ng/mL, and AUC of 944 ± 65 ng/mL·min for the subcutaneous injection group. Both in vivo and in vitro experiments showed that the RHDMNP exerted effective anticoagulant effects, prevented the incidence of acute pulmonary embolism, and revealed the potential for venous thrombosis prevention.

Wireless and battery-free platforms for collection of biosignals

Recent progress in biosensors have quantitively expanded current capabilities in exploratory research tools, diagnostics and therapeutics. This rapid pace in sensor development has been accentuated by vast improvements in data analysis methods in the form of machine learning and artificial intelligence that, together, promise fantastic opportunities in chronic sensing of biosignals to enable preventative screening, automated diagnosis, and tools for personalized treatment strategies. At the same time, the importance of widely accessible personal monitoring has become evident by recent events such as the COVID-19 pandemic. Progress in fully integrated and chronic sensing solutions is therefore increasingly important. Chronic operation, however, is not truly possible with tethered approaches or bulky, battery-powered systems that require frequent user interaction. A solution for this integration challenge is offered by wireless and battery-free platforms that enable continuous collection of biosignals. This review summarizes current approaches to realize such device architectures and discusses their building blocks. Specifically, power supplies, wireless communication methods and compatible sensing modalities in the context of most prevalent implementations in target organ systems. Additionally, we highlight examples of current embodiments that quantitively expand sensing capabilities because of their use of wireless and battery-free architectures.

Effect of non-Newtonian fluid rheology on an arterial bypass graft: A numerical investigation guided by constructal design

In post-operative scenarios of arterial graft surgeries to bypass coronary artery stenosis, fluid dynamics plays a crucial role. Problems such as intimal hyperplasia have been related to fluid dynamics and wall shear stresses near the graft junction. This study focused on the question of the use of Newtonian and non-Newtonian models to represent blood in this type of problem in order to capture important flow features, as well as an analysis of the performance of geometry from the view of Constructive Theory. The objective of this study was to investigate the effects rheology on the steady-state flow and on the performance of a system consisting of an idealized version of a partially obstructed coronary artery and bypass graft. The Constructal Design Method was employed with two degrees of freedom: the ratio between bypass and artery diameters and the junction angle at the bypass inlet. The flow problem was solved numerically using the Finite Volume Method with blood modeled employing the Carreau equation for viscosity. The Computational Fluid Dynamics model associated with the Sparse Grid method generated eighteen response surfaces, each representing a severe stenosis degree of 75% for specific combinations of rheological parameters, dimensionless viscosity ratio, Carreau number and flow index at two distinct Reynolds numbers of 150 and 250. There was a considerable dependence of the pressure drop on rheological parameters. For the two Reynolds numbers studied, the Newtonian case presented the lowest value of the dimensionless pressure drop, suggesting that the choice of applying Newtonian blood may underestimate the value of pressure drop in the system by about 12.4% (Re =150) and 7.8% (Re = 250). Even so, results demonstrated that non-Newtonian rheological parameters did not influence either the shape of the response surfaces or the optimum bypass geometry, which consisted of a diameter ratio of 1 and junction angle of 30°. However, the viscosity ratio and the flow index had the greatest impact on pressure drop, recirculation zones and wall shear stress. Rheological parameters also affected the recirculation zones downstream of stenosis, where intimal hyperplasia is more prevalent. Newtonian and most non-Newtonian results had similar wall shear stresses, except for the non-Newtonian case with high viscosity ratio. In the view of Constructal Design, the geometry of best performance was independent of the rheological model. However, rheology played an important role on pressure drop and flow dynamics, allowing the prediction of recirculation zones that were not captured by a Newtonian model.

Hemodynamic Analysis of VenaTech Convertible Vena Cava Filter Using Computational Fluid Dynamics

The VenaTech convertible filter (VTCF) has been widely used as an inferior vena cava (IVC) filter to prevent fatal pulmonary embolism in patients. However, its hemodynamics that greatly affect the filter efficacy and IVC patency are still unclear. This paper uses computational fluid dynamics with the Carreau model to simulate the non-Newtonian blood flows around the VTCF respectively deployed in the normal, reverse and three converted states in an IVC model. The results show that the prothrombotic stagnation zones are observed downstream from the normal, reverse and small open VTCFs, with the streamwise length is nearly eight times the IVC diameter. The no-slip boundary conditions of the thin-wire VTCF arms lead to the “viscous block” effect. The viscous block accelerates the blood flow by 5–15% inside the IVC and enhances the filter wall shear stress up to nearly 20 times that of the IVC only, which contributes to clot capture and thrombus lysis. The relative flow resistance is defined to evaluate the filter-induced resistance on the IVC blood flow that can be regarded as an index of IVC patency with the filter deployment. The flow resistance of the normal VTCF deployment increases dramatically by more than 60% compared with that of the IVC only and is a little higher (6%) than that of the reverse case. As the VTCF converts to a fully open configuration, the flow resistance gradually decreases to that of no filter. This work shows that even very thin VTCF arms can result in the viscous block effect and may cause significant hemodynamic impacts on clot capture, potential thrombosis and flow impedance inside the IVC. The present study also shows that CFD is a valuable and feasible in silico tool for analyzing the IVC filter hemodynamics to complement in vivo clinical and in vitro experimental studies.

Hemodynamic effects of blood clots trapped by an inferior vena cava filter

The alteration of blood flow around an OPTEASE inferior vena cava filter with one or two blood clots attached was investigated by means of computational fluid dynamics. We used a patient-specific vein wall geometry, and we generated different clot models with shapes adapted to the filter and vein wall geometries. A total of eight geometries, with one or two clots and a total clot volume of 0.5 or 1 cm³ , were considered. A non-Newtonian model for blood viscosity was adopted and the possible development of turbulence was accounted for by means of a three-equation model. Two blood flow rates were considered for each case, representative for rest and exercise conditions. In exercise conditions, flow unsteadiness and even turbulence was detected in some cases. Pressure and wall shear stress (WSS) distributions were modified in all cases. Clots attached to the filter downstream basket considerably increased averaged WSS values by up to almost 50%. In all the cases a flow recirculation region appeared downstream of the clot. The degree of flow stagnation in these regions, an indicator of propensity to thrombogenesis, was estimated in terms of mean residence times and mean blood viscosity. High levels of flow stagnation were detected in rest conditions in the wake of those clots that were placed upstream from the filter. Our results suggest that one downstream placed big clot, showing a higher tendency to induce flow instabilities and turbulence, might be more harmful than two small clots placed in tandem.

A comparative CFD study of four inferior vena cava filters

Computational fluid dynamics was used to simulate the flow of blood within an inferior vena cava (IVC) geometry model that was reconstructed from computed tomography images obtained from a real patient. The main novelty of the present work is that we simulated the implantation of 4 different filter models in this realistic IVC geometry. We considered different blood flow rates in the range between V_in =20 and V_in =80 cm³ /s, and all simulations were performed with both the Newtonian and a non-Newtonian model for the blood viscosity. We compared the hemodynamics performance of the different filter models, and we paid a special attention to the total drag force, F_d , exerted by the blood flow on the filter surface. This force is the sum of 2 contributions: the viscous skin friction force, which was found to be roughly proportional to the filter surface area, and the pressure force, which depended on the particular filter geometry design. The F_d force is relevant because it must be balanced by the total force exerted by the filter hooks/struts on the IVC wall at the attachment locations. For the highest V_in value investigated, the variation in F_d among filters was from 116 to 308 dyne. We also showed how the present results can be extrapolated to obtain good estimates of the drag forces if the blood viscosity levels change, ie, if the patient with a filter implanted is treated with anticoagulant therapy.

Effects of walking in deep venous thrombosis: a new integrated solid and fluid mechanics model

Deep venous thrombosis (DVT) is a common disease. Large thrombi in venous vessels cause bad blood circulation and pain; and when a blood clot detaches from a vein wall, it causes an embolism whose consequences range from mild to fatal. Walking is recommended to DVT patients as a therapeutical complement. In this study the mechanical effects of walking on a specific patient of DVT were simulated by means of an unprecedented integration of 3 elements: a real geometry, a biomechanical model of body tissues, and a computational fluid dynamics study. A set of computed tomography images of a patient's leg with a thrombus in the popliteal vein was employed to reconstruct a geometry model. Then a biomechanical model was used to compute the new deformed geometry of the vein as a function of the fiber stretch level of the semimembranosus muscle. Finally, a computational fluid dynamics study was performed to compute the blood flow and the wall shear stress (WSS) at the vein and thrombus walls. Calculations showed that either a lengthening or shortening of the semimembranosus muscle led to a decrease of WSS levels up to 10%. Notwithstanding, changes in blood viscosity properties or blood flow rate may easily have a greater impact in WSS.