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
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Nomenclature of the end-to-side anastomosis (POS-proximal outlet segment, DOS-distal outlet segment)
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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)
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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.
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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.
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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.
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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).
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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.
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Time-averaged wall shear stress for each axial measurement location at the midplane
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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.
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Comparison of predicted IHT by nonlinear multiple regression with backward elimination with measured IHT. The symbols are identical to those used in Fig. 7.




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