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Longitudinal computational fluid dynamics study of stenosis and aneurysmal degeneration of an aortorenal bypass

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Abstract

Saphenous vein graft (SVG) bypass placement is regarded as the optimal option for renal artery stenosis, which usually causes secondary hypertension and poor renal perfusion. Using computational fluid dynamics, this study aimed to investigate the underlying hemodynamic mechanism of the vein aneurysm and stenosis after aortorenal bypass surgery. Three-dimensional models were reconstructed based on computed tomographic angiography images of a 20-year-old female patient who suffered from uncontrollable hypertension using the image processing package Mimics (Materialise). The morphology and hemodynamic parameters in the healthy state, at initial presentation and at post-operative 9-month and 2-year follow-ups after surgery were analysed. The hemodynamic parameters became normal in the left and right renal arteries after bypass surgery. However, flow separation and stagnation occurred at the post-operative 9-month aorta-vein anastomosis, which caused asymmetrical flow and extremely high wall shear stress (WSS) and WSS gradients at the outflow vein tract, where the stenosis occurred 2 years later. In addition, the graft bending produced an asymmetrical flow pattern downstream. This research revealed that the abnormal hemodynamics, including flow separation and extremely high WSS values and gradients, caused by the retrograde flow of aortorenal bypass may be responsible for the SVG degeneration. In addition, flow asymmetry due to vessel bending is a potential risk factor for SVG aneurysm dilation.

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Funding

This study was supported in part by the National Natural Science Foundation of China [No. 11802253].

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Authors and Affiliations

  1. Department of Applied Mechanics, Sichuan University, Chengdu, 610065, People’s Republic of China

    Zhuxiang Xiong, Zeyang Mou, Yan Li, Zhan Liu & Tinghui Zheng

  2. Department of Computer Science, Sichuan University of Science and Engineering, Zigong, Sichuan, 643000, People’s Republic of China

    Yi Wang

  3. School of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, Sichuan, 621010, People’s Republic of China

    Jun Wen

  4. Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, 610065, People’s Republic of China

    Ding Yuan

  5. Department of Vascular Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, People’s Republic of China

    Ding Yuan

  6. No. 29 Jiuyanqiao Wangjiang Road, Chengdu, 610064, People’s Republic of China

    Tinghui Zheng

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  1. Zhuxiang Xiong
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  2. Yi Wang
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  4. Yan Li
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  6. Jun Wen
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  7. Ding Yuan
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Correspondence to Ding Yuan or Tinghui Zheng.

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Xiong, Z., Wang, Y., Mou, Z. et al. Longitudinal computational fluid dynamics study of stenosis and aneurysmal degeneration of an aortorenal bypass. Biomech Model Mechanobiol 19, 1965–1975 (2020). https://doi.org/10.1007/s10237-020-01320-9

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  • DOI: https://doi.org/10.1007/s10237-020-01320-9

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