title: Flow pattern and shear stress distribution of distal end-to-side anastomoses. A comparison of the instantaneous velocity fields obtained by particle image velocimetry.
abstract: OBJECTIVE
  To describe the local hemodynamics and pressure losses of crural bypass anastomoses using instantaneous velocity fields acquired by particle image velocimetry (PIV).
  
  
  METHODS
  Silastic models of a Taylor patch, a Miller cuff and a femoro-crural patch prosthesis (FCPP) were attached to a circuit driven by a Berlin Heart, providing a pulsatile flow with an amplitude of 450 to 25 ml/min (mean 200 ml/min). An outflow resistance of 0.5 mmHg/ml/min (peripheral resistance units, PRU) was modeled using small silastic tubes providing a phase shift of -12 degrees between flow and pressure curves. The working fluid consisted of a glycerine/water mixture with a viscosity of 4 mPas. Hollow glass spheres with a mean size of 9-13 microm were used as tracer particles. Instantaneous velocity fields were obtained by means of PIV and shear rates as well as shear stresses were calculated. Triggered by the flowmeter signal, 10 measurements at 100 ms intervals per cardiac cycle were obtained. The pressures were measured on the inflow and at both distal outflows. The resulting mean pressure losses due to flow separation and distal fluid acceleration were calculated.
  
  
  RESULTS
  Inside the Taylor patch anastomosis a large flow separation at the hood containing a clockwise rotating vortex was found. Additionally a smaller flow separation at the heel and a flow stagnation zone on the floor of the recipient artery were observed. Conversely, inside the Miller cuff a counterclockwise rotating vortex was seen inside a large heel flow separation. The FCPP also showed typical separation areas at the hood and heel of the anastomosis, although these were smaller compared to the other anastomoses. Inside the FCPP anastomosis no vortex creation was observed throughout the cardiac cycle. The mainstream velocities at the inlet levels were comparable for the three anastomoses. A significant fluid acceleration was present at the antegrade as well as the retrograde outlets of the Taylor and Miller cuff, while the fluid acceleration at the antegrade outflow of the FCPP was small, which was attributed to the end-to-end configuration of the antegrade FCPP leg. The calculated normalized antegrade and retrograde pressure losses for the Taylor form were 0.90 and 0.88, for the Miller cuff 0.89 and 0.86 and for the FCPP 0.94 and 0.86, respectively. The shear stresses inside the flow separations of the three anastomoses were significantly lower than normal wall shear stresses. High shear stress levels were found inside the transition zones between flow separation and high velocity mainstream.
  
  
  CONCLUSIONS
  The flow pattern inside cuffed or funnel shaped anastomoses consists of large flow separation zones, which are thought to be associated with intimal hyperplasia development. In addition, fluid accelerations at the distal outlets result in pressure losses, which may contribute to impaired crural perfusion.
authors.affiliation: Charité, Campus Virchow Klinikum, Department of General Transplantation and Vascular Surgery, Augustenburger Platz 1, Berlin 13353, Germany. michael.heise@charite.de
authors.forename: Michael
authors.initials: M
authors.lastname: Heise
authors.forename: Sven
authors.initials: S
authors.lastname: Schmidt
authors.forename: Ulf
authors.initials: U
authors.lastname: Krüger
authors.forename: Ralph
authors.initials: R
authors.lastname: Rückert
authors.forename: Stefan
authors.initials: S
authors.lastname: Rösler
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
mesh_terms: D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D005263:Femoral Artery; D006439:Hemodynamics; D006801:Humans; D007866:Leg / Q000098:blood supply*