Abstract
Neointimal hyperplasia is amongst the major causes of failure of bypass grafts. The disease progression varies from patient to patient due to a range of different factors. In this paper, a mathematical model will be used to understand neointimal hyperplasia in individual patients, combining information from biological experiments and patient-specific data to analyze some aspects of the disease, particularly with regard to mechanical stimuli due to shear stresses on the vessel wall. By combining a biochemical model of cell growth and a patient-specific computational fluid dynamics analysis of blood flow in the lumen, remodeling of the blood vessel is studied by means of a novel computational framework. The framework was used to analyze two vein graft bypasses from one patient: a femoro-popliteal and a femoro-distal bypass. The remodeling of the vessel wall and analysis of the flow for each case was then compared to clinical data and discussed as a potential tool for a better understanding of the disease. Simulation results from this first computational approach showed an overall agreement on the locations of hyperplasia in these patients and demonstrated the potential of using new integrative modeling tools to understand disease progression.
Highlights
Peripheral bypasses are amongst the most common vascular interventions; the reality is that millions of these bypasses fail due to vascular remodeling and this is a real burden for National Health Systems
From the fluid dynamics simulations, the variable of interest for the model is time averaged wall shear stress (TAWSS), as this is the mechanical factor that has an influence on the turnover of cells
Results of TAWSS were extracted after each step of the remodeling cycle, in order to be used as input data for the biochemical model
Summary
Peripheral bypasses are amongst the most common vascular interventions; the reality is that millions of these bypasses fail due to vascular remodeling and this is a real burden for National Health Systems. Why bypasses fail is a critical issue in vascular surgery today, traditional approaches have not provided answers to this problem. It is essential to mention that as of today, animal experiments to study peripheral grafts have failed dramatically. To put it there are no animal models which would provide useful data to understand lower extremity venous bypass failure in humans and other, novel approaches are urgently required. When a bypass graft blocks, blood supply is usually worse than before bypass surgery. In these circumstances amputation can be inevitable unless the graft can be salvaged and the blood supply restored. Recent randomized controlled trials showed that 40% of lower extremity vein grafts occlude or develop significant stenosis within the
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