Fluid dynamics, wall mechanics, and oxygen transfer in peripheral bypass anastomoses

Intimal hyperplasia at vascular anastomoses seems to be promoted by altered flow conditions and stress distributions within the anastomotic region. In order to gain deeper insight into postoperative disease processes, and subsequently, to contribute to the development of improved vascular reconstructions, detailed studies, also on local flow dynamics and related mass transport and wall mechanical effects, are required. In context with in vivo studies, computer simulation based on casts of femoro-popliteal bypasses implanted into sheep were performed to analyze the flow dynamics, the oxygen transport, and the wall and suture mechanics in anatomically correct bypass configurations related to three established surgical techniques and resulting geometries (conventional type anastomosis, Taylor-patch and Miller-cuff anastomoses with venous interposition grafts of different modifications). The influence of geometry, compliance of the graft, the interponated vein patch and vein cuff, and of the artery was included. Time-dependent, three-dimensional Navier-Stokes equations describing the flow field, and a nonlinear shell structure for the vessel walls were coupled using finite element methods. The numerical results demonstrate nonphysiological flow patterns in the anastomotic region. Strongly skewed axial velocity profiles and secondary velocities occur in the junction region. In the Miller-cuff a vortex may induce a wash-out effect which protects the host artery. On the artery floor opposite the junction flow separation and zones of recirculation were found. The analysis of oxygen transport illustrates a correlation between zones of low wall shear stress and reduced oxygen flux into the wall. Wall mechanics show that increased compliance mismatch leads to increased and discontinuous intramural stresses. Comparison to histomorphological findings on intimal hyperplasia shows certain correlations, particularly increased compliance mismatch has a proliferate influence on suture line hyperplasia. The reduction of compliance mismatch using vein interposition results in decreased generation of intimal hyperplasia, and therefore, contributes to improvement of patency rates, while the geometrical modification and the resulting change of the flow pattern seems to be less important for the growth of anastomotic intimal hyperplasia.