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Watson C, Saaid H, Vedula V, Cardenas JC, Henke PK, Nicoud F, Xu XY, Hunt BJ, Manning KB. Venous Thromboembolism: Review of Clinical Challenges, Biology, Assessment, Treatment, and Modeling. Ann Biomed Eng 2024; 52:467-486. [PMID: 37914979 DOI: 10.1007/s10439-023-03390-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
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.
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Affiliation(s)
- Connor Watson
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Hicham Saaid
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, USA
| | - Jessica C Cardenas
- Department of Surgery and the Center for Translational Injury Research, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Peter K Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Franck Nicoud
- CNRS, IMAG, Université de Montpellier, Montpellier, France
- Institut Universitaire de France, Paris, France
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Beverley J Hunt
- Department of Thrombosis and Haemostasis, King's College, London, UK
- Thrombosis and Haemophilia Centre, Guy's & St Thomas' NHS Trust, London, UK
| | - Keefe B Manning
- Department of Biomedical Engineering, The Pennsylvania State University, 122 Chemical and Biomedical Engineering Building, University Park, PA, 16802-4400, USA.
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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2
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Zhussupbekov M, Méndez Rojano R, Wu WT, Antaki JF. von Willebrand factor unfolding mediates platelet deposition in a model of high-shear thrombosis. Biophys J 2022; 121:4033-4047. [PMID: 36196057 PMCID: PMC9675031 DOI: 10.1016/j.bpj.2022.09.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/21/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022] Open
Abstract
Thrombosis under high-shear conditions is mediated by the mechanosensitive blood glycoprotein von Willebrand factor (vWF). vWF unfolds in response to strong flow gradients and facilitates rapid recruitment of platelets in flowing blood. While the thrombogenic effect of vWF is well recognized, its conformational response in complex flows has largely been omitted from numerical models of thrombosis. We recently presented a continuum model for the unfolding of vWF, where we represented vWF transport and its flow-induced conformational change using convection-diffusion-reaction equations. Here, we incorporate the vWF component into our multi-constituent model of thrombosis, where the local concentration of stretched vWF amplifies the deposition rate of free-flowing platelets and reduces the shear cleaning of deposited platelets. We validate the model using three benchmarks: in vitro model of atherothrombosis, a stagnation point flow, and the PFA-100, a clinical blood test commonly used for screening for von Willebrand disease (vWD). The simulations reproduced the key aspects of vWF-mediated thrombosis observed in these experiments, such as the thrombus location, thrombus growth dynamics, and the effect of blocking platelet-vWF interactions. The PFA-100 simulations closely matched the reported occlusion times for normal blood and several hemostatic deficiencies, namely, thrombocytopenia, vWD type 1, and vWD type 3. Overall, this multi-constituent model of thrombosis enables macro-scale 3D simulations of thrombus formation in complex geometries over a wide range of shear rates and accounts for qualitative and quantitative hemostatic deficiencies in patient blood.
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Affiliation(s)
- Mansur Zhussupbekov
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | | | - Wei-Tao Wu
- Department of Aerospace Science and Technology, Nanjing University of Science and Technology, Nanjing, China
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York.
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Owen DG, de Oliveira DC, Neale EK, Shepherd DET, Espino DM. Numerical modelling of blood rheology and platelet activation through a stenosed left coronary artery bifurcation. PLoS One 2021; 16:e0259196. [PMID: 34731193 PMCID: PMC8565790 DOI: 10.1371/journal.pone.0259196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
Coronary bifurcations are prone to atherosclerotic plaque growth, experiencing regions of reduced wall shear stress (WSS) and increased platelet adhesion. This study compares effects across different rheological approaches on hemodynamics, combined with a shear stress exposure history model of platelets within a stenosed porcine bifurcation. Simulations used both single/multiphase blood models to determine which approach best predicts phenomena associated with atherosclerosis and atherothrombosis. A novel Lagrangian platelet tracking model was used to evaluate residence time and shear history of platelets indicating likely regions of thrombus formation. Results show a decrease in area of regions with pathologically low time-averaged WSS with the use of multiphase models, particularly in a stenotic bifurcation. Significant non-Newtonian effects were observed due to low-shear and varying hematocrit levels found on the outer walls of the bifurcation and distal to the stenosis. Platelet residence time increased 11% in the stenosed artery, with exposure times to low-shear sufficient for red blood cell aggregation (>1.5 s). increasing the risk of thrombosis. This shows stenotic artery hemodynamics are inherently non-Newtonian and multiphase, with variations in hematocrit (0.163-0.617) and elevated vorticity distal to stenosis (+15%) impairing the function of the endothelium via reduced time-averaged WSS regions, rheological properties and platelet activation/adhesion.
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Affiliation(s)
- David G. Owen
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Diana C. de Oliveira
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Emma K. Neale
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Duncan E. T. Shepherd
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Daniel M. Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
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4
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Wu WT, Zhussupbekov M, Aubry N, Antaki JF, Massoudi M. Simulation of thrombosis in a stenotic microchannel: The effects of vWF-enhanced shear activation of platelets. INTERNATIONAL JOURNAL OF ENGINEERING SCIENCE 2020; 147:103206. [PMID: 34565829 PMCID: PMC8462794 DOI: 10.1016/j.ijengsci.2019.103206] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study was undertaken to develop a numerical/computational simulation of von Willebrand Factor (vWF) - mediated platelet shear activation and deposition in an idealized stenosis. Blood is treated as a multi-constituent mixture comprised of a linear fluid component and a porous solid component (thrombus). Chemical and biological species involved in coagulation are modeled using a system of coupled convection-reaction-diffusion (CRD) equations. This study considers the cumulative effect of shear stress (history) on platelet activation. The vWF activity is modeled as an enhancement function for the shear stress accumulation and is related to the experimentally-observed unfolding rate of vWF. A series of simulations were performed in an idealized stenosis in which the predicted platelets deposition agreed well with previous experimental observations spatially and temporally, including the reduction of platelet deposition with decreasing expansion angle. Further simulation indicated a direct relationship between vWF-mediated platelet deposition and degree of stenosis. Based on the success with these benchmark simulations, it is hoped that the model presented here may provide additional insight into vWF-mediated thrombosis and prove useful for the development of more hemo-compatible blood-wetted devices in the future.
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Affiliation(s)
- Wei-Tao Wu
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, J.S., 210094, China
| | - Mansur Zhussupbekov
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Nadine Aubry
- Department of Mechanical Engineering, Northeastern University, Boston, MA, 02115, USA
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Mehrdad Massoudi
- U. S. Department of Energy, National Energy Technology Laboratory (NETL), Pittsburgh, PA, 15236, USA
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Demkin VP, Mel'nichuk SV, Rudenko TV, Tyutrin II, Udut VV. Analysis of Viscoelastic Parameters of Fluids by Low-Frequency Piezoelastography. Bull Exp Biol Med 2020; 168:413-417. [PMID: 31942664 DOI: 10.1007/s10517-020-04721-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Indexed: 10/25/2022]
Abstract
Theoretical and experimental analysis of viscoelastic properties of fluids at low oscillating shear stresses was performed. Mathematic approach for calculating the complex coefficient of viscosity on the basis of experimental data on the amplitude-phase characteristics measured by the method of low-frequency piezoelastography was developed. The dependencies of the amplitude and phase shift of the signal recorded by a piezoelectric detector of a ARP-01M Mednord piezoelectric thromboelastograph on the frequency of forced oscillations of a resonator needle in air, water, and glycerin at fixed temperature of 37°C were studied. It was found that with increasing fluid viscosity, the resonance frequency of oscillations decreases in comparison with the frequency of oscillations in air.
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Affiliation(s)
- V P Demkin
- National Research Tomsk State University, Tomsk, Russia.
| | | | - T V Rudenko
- National Research Tomsk State University, Tomsk, Russia
| | - I I Tyutrin
- Department of Anesthesiology, Resuscitation, and Intensive Therapy, Siberian Medical University, Ministry of Health of the Russian Federation, Tomsk, Russia
| | - V V Udut
- National Research Tomsk State University, Tomsk, Russia
- E. D. Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Tomsk, Russia
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Yesudasan S, Averett RD. Recent advances in computational modeling of fibrin clot formation: A review. Comput Biol Chem 2019; 83:107148. [PMID: 31751883 PMCID: PMC6918949 DOI: 10.1016/j.compbiolchem.2019.107148] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/17/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022]
Abstract
The field of thrombosis and hemostasis is crucial for understanding and developing new therapies for pathologies such as deep vein thrombosis, diabetes related strokes, pulmonary embolisms, and hemorrhaging related diseases. In the last two decades, an exponential growth in studies related to fibrin clot formation using computational tools has been observed. Despite this growth, the complete mechanism behind thrombus formation and hemostasis has been long and rife with obstacles; however, significant progress has been made in the present century. The computational models and methods used in this context are diversified into different spatiotemporal scales, yet there is no single model which can predict both physiological and mechanical properties of fibrin clots. In this review, we list the major strategies employed by researchers in modeling fibrin clot formation using recent and existing computational techniques. This review organizes the computational strategies into continuum level, system level, discrete particle (DPD), and multi-scale methods. We also discuss strengths and weaknesses of various methods and future directions in which computational modeling of fibrin clots can advance.
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Affiliation(s)
- Sumith Yesudasan
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, 597 D.W. Brooks Drive, Athens, GA 30602
| | - Rodney D Averett
- School of Chemical, Materials and Biomedical Engineering, University of Georgia, 597 D.W. Brooks Drive, Athens, GA 30602.
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Gallagher MT, Wain RAJ, Dari S, Whitty JP, Smith DJ. Non-identifiability of parameters for a class of shear-thinning rheological models, with implications for haematological fluid dynamics. J Biomech 2019; 85:230-238. [PMID: 30732907 DOI: 10.1016/j.jbiomech.2019.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/13/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
Choosing a suitable model and determining its associated parameters from fitting to experimental data is fundamental for many problems in biomechanics. Models of shear-thinning complex fluids, dating from the work of Bird, Carreau, Cross and Yasuda, have been applied in highly-cited computational studies of hemodynamics for several decades. In this manuscript we revisit these models, first to highlight a degree of uncertainty in the naming conventions in the literature, but more importantly to address the problem of inferring model parameters by fitting to rheology experiments. By refitting published data, and also by simulation, we find large, flat regions in likelihood surfaces that yield families of parameter sets which fit the data equally well. Despite having almost indistinguishable fits to experimental data these varying parameter sets can predict very different flow profiles, and as such these parameters cannot be used to draw conclusions about physical properties of the fluids, such as zero-shear viscosity or relaxation time of the fluid, or indeed flow behaviours. We verify that these features are not a consequence of the experimental data sets through simulations; by sampling points from the rheological models and adding a small amount of noise we create a synthetic data set which reveals that the problem of parameter identifiability is intrinsic to these models.
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Affiliation(s)
- M T Gallagher
- School of Mathematics, University of Birmingham, B15 2TT, UK; Institute for Metabolism and Systems Research, University of Birmingham, B15 2TT, UK.
| | - R A J Wain
- John Tyndall Institute, School of Engineering, University of Central Lancashire, Preston PR1 2HE, UK; School of Medicine and Dentistry, University of Central Lancashire, Preston PR1 2HE, UK; Institute of Translational Medicine, University of Birmingham, B15 2TT, UK
| | - S Dari
- School of Mathematics, University of Birmingham, B15 2TT, UK
| | - J P Whitty
- John Tyndall Institute, School of Engineering, University of Central Lancashire, Preston PR1 2HE, UK
| | - D J Smith
- School of Mathematics, University of Birmingham, B15 2TT, UK; Institute for Metabolism and Systems Research, University of Birmingham, B15 2TT, UK
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Computational Fluid Dynamics Assessment Associated with Transcatheter Heart Valve Prostheses: A Position Paper of the ISO Working Group. Cardiovasc Eng Technol 2018; 9:289-299. [PMID: 29675697 DOI: 10.1007/s13239-018-0349-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/08/2018] [Indexed: 12/19/2022]
Abstract
The governing international standard for the development of prosthetic heart valves is International Organization for Standardization (ISO) 5840. This standard requires the assessment of the thrombus potential of transcatheter heart valve substitutes using an integrated thrombus evaluation. Besides experimental flow field assessment and ex vivo flow testing, computational fluid dynamics is a critical component of this integrated approach. This position paper is intended to provide and discuss best practices for the setup of a computational model, numerical solving, post-processing, data evaluation and reporting, as it relates to transcatheter heart valve substitutes. This paper is not intended to be a review of current computational technology; instead, it represents the position of the ISO working group consisting of experts from academia and industry with regards to considerations for computational fluid dynamic assessment of transcatheter heart valve substitutes.
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Bhatt M, Montagnon E, Destrempes F, Chayer B, Kazemirad S, Cloutier G. Acoustic radiation force induced resonance elastography of coagulating blood: theoretical viscoelasticity modeling and ex-vivo experimentation. Phys Med Biol 2018; 63:065018. [PMID: 29509143 DOI: 10.1088/1361-6560/aab46a] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Deep vein thrombosis is a common vascular disease that can lead to pulmonary embolism and death. The early diagnosis and clot age staging are important parameters for reliable therapy planning. This article presents an acoustic radiation force induced resonance elastography method for the viscoelastic characterization of clotting blood. The physical concept of this method relies on the mechanical resonance of the blood clot occurring at specific frequencies. Resonances are induced by focusing ultrasound beams inside the sample under investigation. Coupled to an analytical model of wave scattering, the ability of the proposed method to characterize the viscoelasticity of a mimicked venous thrombosis in the acute phase is demonstrated. Experiments with a gelatin-agar inclusion sample of known viscoelasticity are performed for validation and establishment of the proof of concept. In addition, an inversion method is applied in-vitro for the kinetic monitoring of the blood coagulation process of six human blood samples obtained from two volunteers. The computed elasticity and viscosity values of blood samples at the end of the 90 min kinetics were estimated at 411 ± 71 Pa and 0.25 ± 0.03 Pa.s for volunteer #1, and 387 ± 35 Pa and 0.23 ± 0.02 Pa.s for volunteer #2, respectively. The proposed method allowed reproducible time-varying thrombus viscoelastic measurements from samples having physiological dimensions.
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Affiliation(s)
- Manish Bhatt
- Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, H2W 1T8, CANADA
| | - Emmanuel Montagnon
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montreal, Quebec, CANADA
| | - Francois Destrempes
- Laboratory of Biorheology and Medical Ultrasonics Research Center Univeristy of Montreal Hospital, Universite de Montreal, Montreal, CANADA
| | - Boris Chayer
- University of Montreal Hospital Research Center, Montreal, CANADA
| | - Siavash Kazemirad
- Iran University of Science and Technology, Tehran, Tehran, Iran (the Islamic Republic of)
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics , University of Montreal Hospital Research Center, 900 St-Denis, Montreal, Quebec, CANADA
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Afzal MJ, Ashraf MW, Tayyaba S, Hossain MK, Afzulpurkar N. Sinusoidal Microchannel with Descending Curves for Varicose Veins Implantation. MICROMACHINES 2018; 9:E59. [PMID: 30393335 PMCID: PMC6187514 DOI: 10.3390/mi9020059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/16/2022]
Abstract
Approximately 26% of adult people, mostly females, are affected by varicose veins in old age. It is a common reason for distress, loss of efficiency, and worsening living conditions. Several traditional treatment techniques (sclerotherapy and foam sclerotherapy of large veins, laser surgeries and radiofrequency ablation, vein ligation and stripping, ambulatory phlebectomy, and endoscopic vein surgery) have failed to handle this disease effectively. Herein, authors have presented an alternative varicose vein implant method-the descending sinusoidal microchannel (DSMC). DSMC was simulated by Fuzzy logic MATLAB (The MathWorks, Natick, MA, USA) and ANSYS (ANSYS 18.2, perpetual license purchased by Ibadat Education Trust, The University of Lahore, Pakistan) with real and actual conditions. After simulations of DSMC, fabrication and testing were performed. The silver DSMC was manufactured by utilizing a micromachining procedure. The length, width, and depth of the silver substrate were 51 mm, 25 mm, and 1.1 mm, respectively. The measurements of the DSMC channel in the silver wafer substrate were 0.9 mm in width and 0.9 mm in depth. The three descending curves of the DSMC were 7 mm, 6 mm, and 5 mm in height. For pressure, actual conditions were carefully taken as 1.0 kPa to 1.5 kPa for varicose veins. For velocity, actual conditions were carefully taken as 0.02 m/s to 0.07 m/s for these veins. These are real and standard values used in simulations and experiments. At Reynolds number 323, the flow rate and velocity were determined as 1001.0 (0.1 nL/s), 11.4 cm/s and 1015.3 (0.1 nL/s), 12.19 cm/s by MATLAB (The MathWorks, Natick, MA, USA) and ANSYS simulations, respectively. The flow rate and velocity were determined to be 995.3 (0.1 nL/s) and 12.2 cm/s, respectively, at the same Reynolds number (323) in the experiment. Moreover, the Dean number was also calculated to observe Dean vortices. All simulated and experimental results were in close agreement. Consequently, DSMC can be implanted in varicose veins as a new treatment to preserve excellent blood flow in human legs from the original place to avoid tissue damage and other problems.
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Affiliation(s)
| | | | - Shahzadi Tayyaba
- Department of Computer Engineering, The University of Lahore, Lahore 54000, Pakistan.
| | - M Khalid Hossain
- Institute of Electronics, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, Dhaka 1349, Bangladesh.
| | - Nitin Afzulpurkar
- Department of Mechanical Engineering Technology (MCET), Higher Colleges of Technology (HCT), Ras al-Khaimah P.O. Box 4793, UAE.
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