title: Computation of blood flow through collateral circulation of the superficial femoral artery.
abstract: OBJECTIVE
  Obliteration of collaterals during (endo)vascular treatment of peripheral arterial occlusive disease is considered detrimental. We use a model to calculate maximum collateral bed flow of the superficial femoral artery in order to provide insight in their hemodynamic relevance.
  
  
  METHODS
  A computational model was developed using digital subtraction angiographies in combination with Poiseuille's equation and Ohm's law. Lesions were divided into short and long (<15 cm and ≥15 cm, respectively) and into stenosis and occlusions. Data are presented in relation to the calculated maximum healthy superficial femoral artery flow.
  
  
  RESULTS
  Stenotic lesions are longer than occlusive lesions (P < 0.05) and occlusions had more and larger collaterals (P < 0.05). In all four study groups the collateral flow significantly increased the total flow (P < 0.05). The maximum collateral system flow in the stenosis and occlusion groups was 5.1% and 20.8% of healthy superficial femoral artery flow, respectively (P < 0.05), and there were no significant differences between short and long lesions (11.2% and 6.7% of healthy superficial femoral artery flow, respectively).
  
  
  CONCLUSIONS
  The maximum collateral system flow of the superficial femoral artery is only a fraction, with a maximum of one fifth, of healthy superficial femoral artery flow. Effects of collateral vessel occlusion during (endo)vascular treatment may therefore be without detrimental consequences.
authors.affiliation: Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
authors.forename: R R
authors.initials: RR
authors.lastname: Kruse
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands Department of Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Vinke
authors.affiliation: Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
authors.forename: F B
authors.initials: FB
authors.lastname: Poelmann
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Rohof
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Holewijn
authors.affiliation: Department of Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: C H
authors.initials: CH
authors.lastname: Slump
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands mmpj.reijnen@gmail.com.
authors.forename: Mmpj
authors.initials: M
authors.lastname: Reijnen
mesh_terms: D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity; D003097:Collateral Circulation; D003198:Computer Simulation; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000295:instrumentation; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008955:Models, Cardiovascular; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D012039:Regional Blood Flow; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents
keywords: Covered stent; collaterals; computational model; flow; superficial femoral artery