Abstract

Graft failure is currently a major concern for medical practitioners in treating Peripheral Vascular Disease (PVD) and Coronary Artery Disease (CAD). It is now widely accepted that unfavourable haemodynamic conditions play an essential role in the formation and development of intimal hyperplasia, which is the main cause of graft failure. This paper uses Computational Fluid Dynamics (CFD) to conduct a parametric study to enhance the design and performance of a novel prosthetic graft, which utilises internal ridge(s) to induce spiral flow. This design is primarily based on the identification of the blood flow as spiral in the whole arterial system and is believed to improve the graft longevity and patency rates at distal graft anastomoses. Four different design parameters were assessed in this work and the trailing edge orientation of the ridge was identified as the most important parameter to induce physiological swirling flow, while the height of the ridge also significantly contributed to the enhanced performance of this type of graft. Building on these conclusions, an enhanced configuration of spiral graft is proposed and compared against conventional and spiral grafts to reaffirm its potential benefits.

Highlights

  • Arterial Bypass Graft (ABG) stenosis is currently a major concern for surgeons worldwide in treating coronary and peripheral arterial diseases

  • It is widely accepted that haemodynamic factors play an important role in the formation and development of Intimal Hyperplasia (IH)[4, 5] and acute thrombosis, which are the main causes of ABG and Arterio-Venous Grafts (AVGs) failures

  • The benefit of this flow pattern lies in removing unfavourable haemodynamic environment such as turbulence, stagnation and oscillatory shear stress[7, 8], which are believed to be the main causes of intimal hyperplasia at anastomotic configurations

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Summary

Introduction

Arterial Bypass Graft (ABG) stenosis is currently a major concern for surgeons worldwide in treating coronary and peripheral arterial diseases. One of the most significant contributions to the improvement of haemodynamics in grafts was based on a research which showed that the ‘spiral flow’ is a natural phenomenon in the whole arterial system and is induced by the twisting of the left ventricle during contraction and accentuated upon entering the aortic arch[6]. The benefit of this flow pattern lies in removing unfavourable haemodynamic environment such as turbulence, stagnation and oscillatory shear stress[7, 8], which are believed to be the main causes of intimal hyperplasia at anastomotic configurations. Similar improvements were found when using the spiral flow graft for AV access for haemodialysis (‘Spiral Flow AV Access Graft’)

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