Computational fluid dynamics in abdominal aorta bifurcation: non-Newtonian versus Newtonian blood flow in a real case study

Investigating the Hydrodynamics of Intravenous Drug Infusions

One of the most common reported adverse events for intravenous (IV) infusions are infusion site reactions, ranging from redness and pain at the site of infusion to thrombophlebitis.  The connection between drug infusion and what drives these adverse events is not well understood. To aid in understanding these phenomena, it is crucial to accurately characterize the evolving hemodynamic environment of the infusion site when developing new intravenous formulations, as too rapid dilution may cause precipitation in the vein, while too little dilution might contribute to phlebitis. In this study, a Large-Eddy Simulation (LES) turbulence modeling inside a Computational Fluid Dynamics (CFD) framework has been used to simulate the flow and mixing characteristics of an infusion entering the bloodstream. This work represents the first such study reporting transient flow fields for intravenous infusions using LES CFD simulations with a realistic non-Newtonian blood model. The output of the CFD model closely resembled the flow and mixing patterns generated in benchtop tests for infusions into a blood analogue and water as the venous fluid across a wide range of flow rates.  These models were then investigated further to compare how changes to the fluid rheology model, needle orientation and needle position within the vein resulted in altered mixing regimes at different flow rates.

Toward a Mesoscopic Modeling Approach of Magnetohydrodynamic Blood Flow in Pathological Vessels: A Comprehensive Review

The investigation of magnetohydrodynamic (MHD) blood flow within configurations that are pertinent to the human anatomy holds significant importance in the realm of scientific inquiry because of its practical implications within the medical field. This article presents an exhaustive appraisal of the diverse applications of magnetohydrodynamics and their computational modeling in biological contexts. These applications are classified into two categories: simple flow and pulsatile flow. An alternative approach of traditional CFD methods called Lattice Boltzmann Method (LBM), a mesoscopic method based on kinetic theory, is introduced to solve complex problems, such as hemodynamics. The results show that the flow velocity reduces considerably by increasing the magnetic field intensity, and the flow separation area is minimized by the increase of magnetic field strength. The LBM with BGK collision model has shown good results in terms of precision. Finally, this literature review has revealed a number of potential avenues for further research. Suggestions for future works are proposed accordingly.

Classification of Blood Rheological Models through an Idealized Symmetrical Bifurcation

The assumed rheological behavior of blood influences the hemodynamic characteristics of numerical blood flow simulations. Until now, alternative rheological specifications have been utilized, with uncertain implications for the results obtained. This work aims to group sixteen blood rheological models in homogeneous clusters, by exploiting data generated from numerical simulations on an idealized symmetrical arterial bifurcation. Blood flow is assumed to be pulsatile and is simulated using a commercial finite volume solver. An appropriate mesh convergence study is performed, and all results are collected at three different time instants throughout the cardiac cycle: at peak systole, early diastole, and late diastole. Six hemodynamic variables are computed: the time average wall shear stress, oscillatory shear index, relative residence time, global and local non-Newtonian importance factor, and non-Newtonian effect factor. The resulting data are analyzed using hierarchical agglomerative clustering algorithms, which constitute typical unsupervised classification methods. Interestingly, the rheological models can be partitioned into three homogeneous groups, whereas three specifications appear as outliers which do not belong in any partition. Our findings suggest that models which are defined in a similar manner from a mathematical perspective may behave substantially differently in terms of the data they produce. On the other hand, models characterized by different mathematical formulations may belong to the same statistical group (cluster) and can thus be considered interchangeably.

Numerical investigation of different viscosity models on pulsatile blood flow of thoracic aortic aneurysm (TAA) in a patient-specific model

Aortic aneurysm is one of the most common aortic diseases that can lead to unfortunate consequences. Numerical simulations have an important role in the prediction of the aftereffects of vascular diseases including aneurysm. In this research, numerical simulation of pulsatile blood flow is performed for a 3-dimensional patient-specific model of a thoracic aortic aneurysm (TAA). Since the choice of blood viscosity model may have a significant impact on the simulation results, the effects of four non-Newtonian models of blood viscosity namely Carreau, Casson, Herschel-Bulkley, power low, and the Newtonian model on the wall shear stress (WSS) distribution, shear rate, and oscillatory shear index (OSI) have been analyzed. Simulation results showed that all the non-Newtonian and Newtonian models generally, predict similar patterns for blood flow and shear rate. At high flow rates in the cardiac cycle, the WSS value for all the models are similar to each other except for the power-law model due to the shear thinning behavior. All models predict high values of OSI on the inner wall of the ascending aorta and broad areas of the inner wall of the aneurysm sac. However, the Newtonian model predicts the OSI less than the non-Newtonian models in some areas of the aneurysm sac. Results indicated that the Newtonian model generally can predict the hemodynamic parameters of the blood flow similar to the non-Newtonian but for more precise analysis and to predict the regions prone to rupture and atherosclerosis, choosing a proper non-Newtonian model is recommended.

Simulation of Mechanical Heart Valve Dysfunction and the Non-Newtonian Blood Model Approach

The mechanical heart valve (MHV) is commonly used for the treatment of cardiovascular diseases. Nonphysiological hemodynamic in the MHV may cause hemolysis, platelet activation, and an increased risk of thromboembolism. Thromboembolism may cause severe complications and valve dysfunction. This paper thoroughly reviewed the simulation of physical quantities (velocity distribution, vortex formation, and shear stress) in healthy and dysfunctional MHV and reviewed the non-Newtonian blood flow characteristics in MHV. In the MHV numerical study, the dysfunction will affect the simulation results, increase the pressure gradient and shear stress, and change the blood flow patterns, increasing the risks of hemolysis and platelet activation. The blood flow passes downstream and has obvious recirculation and stagnation region with the increased dysfunction severity. Due to the complex structure of the MHV, the non-Newtonian shear-thinning viscosity blood characteristics become apparent in MHV simulations. The comparative study between Newtonian and non-Newtonian always shows the difference. The shear-thinning blood viscosity model is the basics to build the blood, also the blood exhibiting viscoelastic properties. More details are needed to establish a complete and more realistic simulation.

Assessment of turbulent blood flow and wall shear stress in aortic coarctation using image-based simulations

In this study, we analyzed turbulent flows through a phantom (a 180[Formula: see text] bend with narrowing) at peak systole and a patient-specific coarctation of the aorta (CoA), with a pulsating flow, using magnetic resonance imaging (MRI) and computational fluid dynamics (CFD). For MRI, a 4D-flow MRI is performed using a 3T scanner. For CFD, the standard [Formula: see text], shear stress transport [Formula: see text], and Reynolds stress (RSM) models are applied. A good agreement between measured and simulated velocity is obtained for the phantom, especially for CFD with RSM. The wall shear stress (WSS) shows significant differences between CFD and MRI in absolute values, due to the limited near-wall resolution of MRI. However, normalized WSS shows qualitatively very similar distributions of the local values between MRI and CFD. Finally, a direct comparison between in vivo 4D-flow MRI and CFD with the RSM turbulence model is performed in the CoA. MRI can properly identify regions with locally elevated or suppressed WSS. If the exact values of the WSS are necessary, CFD is the preferred method. For future applications, we recommend the use of the combined MRI/CFD method for analysis and evaluation of the local flow patterns and WSS in the aorta.

Comparative evaluation of ballet-type and conventional stent graft configurations for endovascular aneurysm repair: A CFD analysis

PURPOSE:

Cross limb stent graft (SG) configuration technique for endovascular aneurysm repair (EVAR) is employed for splayed aortic bifurcations to avoid device kinking and smoothen cannulation. The present study investigates three types of stent graft (SG) configurations for endovascular aneurysm repair (EVAR) in abdominal aortic aneurysm. A computational fluid dynamic analysis was performed on the pulsatile non-Newtonian flow characteristics in three ideally modeled geometries of abdominal aortic (AA) SG configurations.

METHODS:

The three planar and crosslimb SG configurations were ideally modeled, namely, top-down nonballet-type, top-down ballet-type, and bottom-up nonballet-type configurations. In top-down SG configuration, most of the device is deployed in the main body in the vicinity of renal artery and the limbs are extended to the iliac artery. While in the bottom-up configuration, some of the SG device is deployed in the main body, the limbs are deployed in aortic bifurcation, and the extra stent graft of the main body is extended to the proximal aorta until the below of the renal artery. The effects of non-Newtonian pulsatile flow on the wall stresses and flow patterns of the three models were investigated and compared. Moreover, the average wall shear stress (AWSS), oscillatory shear stress index (OSI), absolute helicity, pressure distribution, graft displacement and flow visualization plots were analyzed.

RESULTS:

The top-down ballet-type showed less branch blockage effect than the top-down nonballet-type models. Furthermore, the top-down ballet-type configuration showed an increased tendency to sustain high WSS and higher helicity characteristics than that of the bottom-up and top-down non-ballet type configurations. However, displacement forces of the top-down ballet-type configuration were 40% and 9.6% higher than those of the bottom-up and top-down nonballet-type configurations, respectively.

CONCLUSIONS:

Some complications such as graft tearing, thrombus formation, limb disconnection during long term follow up periods might be relevant to hemodynamic characteristics according to the configurations of EVAR. Hence, the reported data required to be validated with the clinical results.

Toward the improvement of 3D-printed vessels' anatomical models for robotic surgery training

Multi-Detector Computed Tomography is nowadays the gold standard for the pre-operative imaging for several surgical interventions, thanks to its excellent morphological definition. As for vascular structures, only the blood flowing inside vessels can be highlighted, while vessels' wall remains mostly invisible. Image segmentation and three-dimensional-printing technology can be used to create physical replica of patient-specific anatomy, to be used for the training of novice surgeons in robotic surgery. To this aim, it is fundamental that the model correctly resembles the morphological properties of the structure of interest, especially concerning vessels on which crucial operations are performed during the intervention. To reach the goal, vessels' actual size must be restored, including information on their wall. Starting from the correlation between vessels' lumen diameter and their wall thickness, we developed a semi-automatic approach to compute the local vessels' wall, bringing the vascular structures as close as possible to their actual size. The optimized virtual models are suitable for manufacturing by means of three-dimensional-printing technology to build patient-specific phantoms for the surgical simulation of robotic abdominal interventions. The proposed approach can effectively lead to the generation of vascular models of optimized thickness wall. The feasibility of the approach is also tested on a selection of clinical cases in abdominal surgery, on which the robotic surgery is performed on the three-dimensional-printed replica before the actual intervention.