Computational simulation of flow-induced arterial remodeling of the pancreaticoduodenal arcade associated with celiac artery stenosis
Computational simulation of flow-induced arterial remodeling of the pancreaticoduodenal arcade associated with celiac artery stenosis
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DOI：
10.1016/j.jbiomech.2019.05.043
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发表时间：
2019-07-19
影响因子：
2.4
通讯作者：
Oshima, Marie
中科院分区：
文献类型：
--
作者：
Yuhn, Changyoung;Hoshina, Katsuyuki;Oshima, Marie
胰十二指肠弓的动脉重塑，使侧支血流到肝脏，脾脏和胃，是腹腔动脉（CA）狭窄的公认临床体征。然而，血流动力学的变化，由于重塑知之甚少，尽管他们的重要性，如胰腺切除术的外科手术。在这项研究中，开发了一个框架来模拟病理性血流改变后的动脉网络重构，并应用于研究CA狭窄患者的血流动力学特征。一个一维零维心血管模型用于血流模拟。在将CA狭窄引入正常网络后，通过迭代地改变每个动脉的直径直到时间平均壁剪切应力达到其在正常条件下的值来模拟动脉重构。模拟一个代表性病例以验证本框架，然后模拟病例以研究狭窄严重程度对重塑结果的影响。观察到一个明显扩张的拱，其直径与在CA狭窄受试者中测量的相应值一致，证实了框架预测动脉重塑的能力。一系列模拟阐明了重塑后的几何形状和血流动力学如何随狭窄程度而变化。特别是，动脉重塑和由此产生的血流再分布被发现保持足够的器官血液供应，无论狭窄的严重程度。此外，有人建议，在CA狭窄患者的流动条件可以估计几何因素，即狭窄的严重程度和拱直径，这可以术前和非侵入性测量使用诊断医学图像。(C)2019爱思唯尔有限公司版权所有。
Arterial remodeling of the pancreaticoduodenal arcade, which enables collateral flow to the liver, spleen, and stomach, is a well-recognized clinical sign of celiac artery (CA) stenosis. However, the hemodynamic changes due to remodeling are poorly understood, despite their importance in surgical procedures such as pancreaticoduodenectomy. In this study, a framework to simulate remodeling of the arterial network following pathological flow alterations was developed and applied to investigate the hemodynamic characteristics of patients with CA stenosis. A one-dimensional-zero-dimensional cardiovascular model was used for blood flow simulation. After introducing CA stenosis into the normal network, arterial remodeling was simulated by iteratively changing the diameter of each artery until time-averaged wall shear stress reached its value under normal conditions. A representative case was simulated to validate the present framework, followed by simulation cases to investigate the impact of stenosis severity on remodeling outcome. A markedly dilated arcade was observed whose diameter agreed well with the corresponding values measured in subjects with CA stenosis, confirming the ability of the framework to predict arterial remodeling. A series of simulations clarified how the geometry and hemodynamics after remodeling change with stenosis severity. In particular, the arterial remodeling and resulting blood flow redistribution were found to maintain adequate organ blood supply regardless of stenosis severity. Furthermore, it was suggested that flow conditions in patients with CA stenosis could be estimated from geometric factors, namely, stenosis severity and arcade diameter, which can be preoperatively and non-invasively measured using diagnostic medical images. (C) 2019 Elsevier Ltd. All rights reserved.