Experimental Study On Anastomotic Hemodynamics Using Tomographic Particle Image Velocimetry

Abstract

Fluid mechanics is an important factor to the failure of the graft anastomosis surgery. In order to better understand the mechanism of restenosis and graft failure of the anastomosis from the perspective of fluid mechanics, an end-toside silicone anastomosis model with 45° anastomotic angle was used for research. The anastomosis model was connected to a continuous flow loop. where the flow rate can be adjusted during the experiment to simulate several conditions. The tomographic particle image velocimetry (TPIV) was applied to obtain the internal three-dimensional and three-component (3D-3C) flow field. The hemodynamics inside the anastomosis model was quantitatively analyzed based on the averaged 3D-3C flow field. The results present that there are phenomena such as recirculation, spiral flow, flow stagnation, and large vortex structures inside the anastomotic flow field. The oscillation of the recirculation zone size and flow stagnation point indicate the fluid stimulation to the endothelial cells. Also, the double spiral vortex structure could cause high local shear stress, which in turn cause trauma to the red blood cells and lead to local coagulation. Besides, thanks to the 3D-3C flow field, the wall shear stress (WSS) on the entire model wall was obtained, which enables us to predict the mechanical influence to the intimal hyperplasia. The local low WSS was found near the graft toe and recirculation regions, while the local high WSS was found on the host vessel bottom where the jet directly impinges. The abnormal flow phenomena can explain the high-risk regions in the anastomosis, where the stenosis and intimal hyperplasia are prone to appear. The 3D-3C flow field based on the in vitro experiment can strengthen the understanding of the anastomotic restenosis pathology and provide further reference for the surgery improvement.