Relative Contribution of Wall Shear Stress and Injury in Experimental Intimal Thickening at PTFE End-to-Side Arterial Anastomoses

[+] Author and Article Information
Francis Loth

Departments of Mechanical Engineering and Bioengineering, University of Illinois at Chicago, Chicago, IL

Steven A. Jones

The Biomedical Engineering Program, Louisiana Tech University, Ruston, LA

Christopher K. Zarins

The Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Tech/Emory, Atlanta, GA

Don P. Giddens

The Department of Surgery, Stanford University, Stanford, CA

Raja F. Nassar

The Biomedical Engineering and Mathematics Programs, Louisiana Tech University, Ruston, LA

Seymour Glagov

The Departments of Surgery and Pathology, The University of Chicago, Chicago, IL

Hisham S. Bassiouny

The Department of Surgery, The University of Chicago, Chicago, IL

J Biomech Eng 124(1), 44-51 (Sep 17, 2001) (8 pages) doi:10.1115/1.1428554 History: Received May 26, 2000; Revised September 17, 2001
Copyright © 2002 by ASME
Your Session has timed out. Please sign back in to continue.


Imparato,  A. M., Bracco,  A., Kim,  G. E., and Zeff,  R., 1972, “Intimal and Neointimal Fibrous Proliferation Causing Failure of Arterial Reconstruction,” Surgery, 72, pp. 1007–1017.
Echave,  V., Koornick,  A., Haimov,  M., and Jacobson,  J., 1979, “Intimal Hyperplasia as a Complication of the Use of the Polytetrafluoroethylene Graft for Femoral-Popliteal Bypass,” Surgery, 86, pp. 791–798.
Pedrini,  L., Pisano,  E., Donato,  Di Paola M., Balleste,  A., and Magnoni,  F., 1994, “Late Occlusion of Aortofemoral Bypass Graft: Surgical Treatment,” Cardiovasc. Surg., 2, pp. 763–766.
Zempo,  N., Esato,  K., O-Hara,  M., Fujioka,  K., Kuga,  T., and Takenaka,  H., 1993, “Is the Preferential Use of Polytetrafluoroethylene Grafts for Below-Knee Femoropopliteal Bypass Justified?” Int. Surg., 78, pp. 162–165.
Bryan,  A. J., and Angelini,  G. D., 1994, “The Biology of Saphenous Vein Graft Occlusion: Etiology and Strategies for Prevention,” Curr. Opin. Cardiol., 9, pp. 641–649.
Waller,  B. F., Pinkerton,  C. A., and Foster,  L. N., 1987, “Morphologic Evidence of Accelerated Left Main Coronary Artery Stenosis: A Later Complication of Percutaneous Transluminal Balloon Angioplasty of the Proximal Left Anterior Descending Coronary Artery,” J. Am. Coll. Cardiol., 9, pp. 1019–1023.
Liu,  M. W., Roubin,  G. S., and King,  S. B., 1989, “Restenosis After Coronary Angioplasty: Potential Biologic Determinants and Role of Intimal Hyperplasia,” Circulation, 79, pp. 1374–1387.
Glagov,  S., 1994, “Intimal Hyperplasia, Vascular Modeling and the Restenosis Problem,” Circulation, 89, pp. 2888–2891.
LoGerfo,  F. W., Soncrant,  T., Teel,  T., and Dewey,  C. F., 1979, “Boundary Layer Separation in Models of Side-to-End Arterial Anastomoses,” Archives of Surgery , 114, pp. 1369–1373.
Clark,  R. E., Apostolou,  S., and Kardos,  J. L., 1976, “Mismatch of Mechanical Properties as a Cause of Arterial Prosthesis Thrombosis,” Surg. Forum, 27, pp. 208–210.
LoGerfo,  F. W., Quist,  W. C., Nowak,  M. D., Crawshaw,  H. M., and Haudenschild,  C. C., 1983, “Downstream Anastomotic Hyperplasia. A Mechanism of Failure in Dacron Arterial Grafts,” Ann. Surgery, 197, pp. 479–483.
Clowes,  A. W., Gown,  A. M., Hanson,  S. R., and Reidy,  M. A., 1985, “Mechanisms of Arterial Graft Failure, Role of Cellular Proliferation in Early Healing of PTFE Prostheses,” Am. J. Pathol., 118, pp. 43–54.
Kamiya,  A., and Togawa,  T., 1980, “Adaptive Regulation of Wall Shear Stress to Flow Change in the Canine Carotid Artery,” Am. J. Pathol., 239, pp. H14–H21.
Langille,  B. L., and O’Donnell,  F., 1986, “Reductions in Arterial Diameter Produced by Chronic Decreases in Blood Flow are Endothelium-Dependent,” Science, 231, pp. 405–407.
Zarins,  C. K., Zatina,  M. A., Giddens,  D. P., Ku,  D. N., and Glagov,  S., 1987, “Shear Stress Regulation of Artery Lumen Diameter in Experimental Atherogenesis,” J. Vasc. Surg., 5, pp. 413–420.
Geary,  R. L., Kohler,  T. R., Vergel,  S., Kirkman,  T. R., and Clowes,  A. W., 1994, “Time Course of Flow-Induced Smooth Muscle Cell Proliferation and Intimal Thickening in Endothelialized Baboon Vascular Grafts,” Circ. Res., 74, pp. 14–23.
Sottiurai,  V. S., Yao,  J. S. T., Batson,  R. C., Sue,  S. L., Jones,  R., and Nakamura,  Y. A., 1989, “Distal Anastomotic Intimal Hyperplasia: Histopathologic Character and Biogenesis,” Ann. Vasc. Surg., 24, pp. 711–722.
Ojha,  M., Ethier,  C. R., Johnston,  K. W., and Cobbold,  R. S., 1990, “Steady and Pulsatile Flow Fields in an End-to-Side Arterial Anastomosis Model,” J. Vasc. Surg., 12, pp. 747–753.
Ojha,  M., 1994, “Wall Shear Stress Temporal Gradient and Anastomotic Intimal Hyperplasia,” Circ. Res., 74, pp. 1227–1231.
White,  S. S., Zarins,  C. K., Giddens,  D. P., Bassiouny,  H. S., Loth,  F., Jones,  S. A., and Glagov,  S., 1993, “Hemodynamic Patterns in a Model of End-to-Side Vascular Graft Anastomoses: Effect of Pulsatility, Flow Division and Reynolds Number and Hood Length,” ASME J. Biomech. Eng., 115, pp. 105–111.
Keynton,  R., Chapman,  M. M., Simms,  R. L., Rodway,  N., and Rittgers,  S. E., 1995, “Direct Relationship between Wall Shear Rate and Intimal Hyperplasia in Vascular Bypass Grafts,” ASME BED Advances in Bioengineering, Vol. 31, pp. 169–170.
Bassiouny,  H. S., White,  S., Glagov,  S., Choi,  E., Giddens,  D. P., and Zarins,  C. K., 1991, “Anastomotic Intimal Hyperplasia: Mechanical Injury or Flow Induced,” J. Vasc. Surg., 15, pp. 708–717.
Bassiouny,  H. S., Krievins,  D., Glagov,  S., Abu-hamid,  G., and Zarins,  C. K., 1993, “Distal Arteriovenous Fistula Inhibits Experimental Anastomotic Intimal Thickening,” Surg. Forum, XLIV, pp. 345–346.
Giddens, E. M., Giddens, D. P., White, S. S., Zarins, C. K., Bassiouny, H. S., and Glagov, S., 1993, “Exercise Flow Conditions Eliminate Stasis at Vascular Graft Anastomoses,” Proceedings of the Third Mid-Atlantic Conference in Biofluid Mechanics, pp. 255–267.
Bassiouny, H. S., Ng, A., and Glagov, S., “Low Shear Stress Enhances Progression of Anastomotic Intimal Hyperplasia,” Submitted to Ann. Vasc. Surg.
Cleary, J. P., and Levenbach, H., 1982, The Professional Forecaster: The Forecasting Process Through Data Analysis, Lifetime Learning Publications, Belmont, Ca.
Loth, F., 1993, “Velocity and Wall Shear Measurements Inside a Vascular Graft Model Under Steady and Pulsatile Flow Conditions,” Ph.D. Thesis, Georgia Institute of Technology, Atlanta, GA.
Loth,  F., Jones,  S. A., Giddens,  D. P., Bassiouny,  H. S., Zarins,  C. K., and Glagov,  S., 1997, “Measurements of Velocity and Wall Shear Stress Inside a PTFE Vascular Graft Model Under Steady Flow Conditions,” ASME J. Biomech. Eng., 119, pp. 187–194.
Loth, F., Jones, S. A., Giddens, D. P., and Brossollet, L. J., 1994, “Accuracy of Wall Shear Stress Estimates from Laser Doppler Anemometry Measurements Under Unsteady Flow Conditions,” Advances in Bioengineering, Proceedings of the ASME Winter Annual Meeting, pp. 307–308.
Ku,  D. N., Giddens,  D. P., Zarins,  C. K., and Glagov,  S., 1985, “Pulsatile Flow and Atherosclerosis in the Human Carotid Bifurcation: Positive Correlation Between Plaque Location and Low and Oscillating Shear Stress,” Arteriosclerosis 5, pp. 293–302.
Glagov, S., and Zarins, C. K., 1983, “Quantitating Atherosclerosis; Problems of Definition in Clinical Diagnosis,” Clinical Diagnosis of Atherosclerosis Quantitative Methods of Evaluation, M. Bond et al., eds., Springer-Verlag, New York, pp. 11–35.
Zarins,  C. K., Giddens,  D. P., Bharadvaj,  B. K., Sottiurai,  V. S., Mabon,  R. F., and Glagov,  S., 1983, “Carotid Bifurcation Atherosclerosis: Quantitative Correlation of Plaque Localization With Flow Velocity Profiles and Wall Shear Stress,” Circ. Res., 53, pp. 502–514.
Bharadvaj,  B. K., Mabon,  R. F., and Giddens,  D. P., 1982, “Steady Flow in a Model of the Human Carotid Bifurcation: I. Flow Visualization,” ASME J. Biomech. Eng., 15, pp. 348–362.
Svindland,  A., 1983, “The Localization of Subanophilie and Fibrous Plaques in the Main Left Coronary Arteries,” Atherosclerosis 48, pp. 139–145.
Fox,  B., James,  K., Morgan,  B., and Seed,  A., 1982, “Distribution of Fatty and Fibrous Plaques in Young Human Coronary Arteries,” Atherosclerosis 41, pp. 337–347.
Sabbah,  H. N., Khaja,  F., Brymer,  J. F., Hawkins,  E. T., and Stein,  P. D., 1984, “Blood Velocity in the Right Coronary Artery: Relation to the Distribution of Atherosclerotic Lesions,” Am. J. Cardiol., 53, pp. 1008–1012.
Friedman,  M. H., Bargeron,  C. B., Deters,  O. J., Hutchins,  G. M., and Mark,  F. F., 1987, “Correlation Between Wall Shear and Intimal Thickness at a Coronary Artery Branch,” Atherosclerosis 68, pp. 27–33.
Tang, T., 1990, “Periodic Flow in a Bifurcating Tube at Moderate Reynolds Number,” Ph.D. Thesis, Georgia Institute of Technology, Atlanta, GA.
Asakura,  T., and Karino,  T., 1990, “Flow Patterns and Spatial Distribution of Atherosclerotic Lesions in Human Coronary Arteries,” Circ. Res., 66, pp. 1045–66.
Krams,  R., Wentzel,  J. J., Oomen,  J. A. F., Vinke,  R., Schuurbiers,  J. C. H., Feyter,  P. J., Serruys,  P. W., and Stager,  C. J., 1997, “Evaluation of Endothelial Shear Stress and 3D Geometry as Factors Determining the Development of Atherosclerosis and Remodeling in Human Coronary Arteries in Vitro, Combining 3D Reconstruction from Angiography and IVUS (ANGUS) With Computational Fluid Dynamics,” Arterioscler., Thromb., Vasc. Biol., 17, pp. 2061–2065.
Moore,  J. E., Xu,  C., Glagov,  S., Zarins,  C. K., and Ku,  D. N., 1994, “Fluid Wall Shear Stress Measurements in a Model of the Human Abdominal Aorta; Oscillatory behavior and relationship to Atherosclerosis,” Atherosclerosis 110, pp. 225–240.
Papadaki,  M., McIntire,  L. V., and Eskin,  S. G., 1996, “Effects of Shear Stress on the Growth Kinetics of Human Aortic Smooth Muscle Cells in Vitro,” Biotechnol. Bioeng., 50, pp. 555–561.
Alshihabi,  S. N., Chang,  Y. S., Frangos,  J. A., and Tarbell,  J. M., 1996, “Shear Stress-Induced Release of PGE2 and PGI2 by Vascular Smooth Muscle Cells,” Biochem. Biophys. Res. Commun., 224, pp. 808–814.
Gadson,  P. F., Rossignol,  C., McCoy,  J., and Rosenquist,  T. H., 1993, “Expression of Elastin, Smooth Muscle Alpha-Actin, and C-Jun as a Function of the Embryonic Lineage of Vascular Smooth Muscle Cells,” In Vitro Cell. Dev. Biol.: Anim., 29A, pp. 773–781.


Grahic Jump Location
Nomenclature of the end-to-side anastomosis (POS-proximal outlet segment, DOS-distal outlet segment)
Grahic Jump Location
Sketch showing the surgical bypass configuration in which blood bypasses an occlusion (ligation) through the PTFE and exits the distal anastomosis through both the proximal outlet segment (POS) and the distal outlet segment (DOS)
Grahic Jump Location
Regions on the hood and floor over which IHT was averaged circumferentially. Five intimal thickening values, 15 degrees apart, were used in the calculation for IHT for each region.
Grahic Jump Location
Geometry for the in vitro flow model. Wall shear stress measurements were obtained at the axial locations indicated by the dotted lines. The cross-sections of the model at each of these axial locations are indicated.
Grahic Jump Location
Flow waveform used for the in vitro velocity measurements. The flow rate has been scaled to reflect the equivalent in vivo values. POS and DOS are the proximal and distal outflow segments, respectively.
Grahic Jump Location
Histomicrographs of graft hood and arterial floor IHT (×120 mag), cross-sections were stained using the Gomori-trichrome-aldehyde fuchsin procedure for connective tissue staining. Graft hood IHT (Fig. 6(a)) consists of an intimal pannus morphologically consistent with smooth muscle cells overlying the PTFE graft. There is no evidence of mural or luminal thrombosis. Floor IHT is represented in Fig. 6(b) (×120 mag).
Grahic Jump Location
Distribution of mean IHT at the different axial locations in the experimental end-to-side anastomosis. IHT is along the graft hood and heel is more prominent than other regions within the anastomosis. IHT was absent on the floor of the graft.
Grahic Jump Location
Time-averaged wall shear stress for each axial measurement location at the midplane
Grahic Jump Location
Linear regression of the reciprocal of mean wall shear (1/WSS) and mean IHT. Filled symbols are along the floor (native artery). Open symbols are along the hood (PTFE). The triangles are near the suture line. The diamond is the floor stagnation point. Locations other than the suture line and stagnation point are represented with boxes. While a correlation is seen between IHT and 1/WSS, the degree of correlation is reduced by the influence of material and injury. The IHT values along the native artery are generally lower than those along PTFE for a given level of shear stress. Also, IHT values near the suture line are higher than those away from the suture line for a given material and a given wall shear stress level.
Grahic Jump Location
Comparison of predicted IHT by nonlinear multiple regression with backward elimination with measured IHT. The symbols are identical to those used in Fig. 7.




Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In