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Computational Fluid Dynamics : a clinician's tool for Femoral Artery Stenosis?

Velde, Lennart van de (2018) Computational Fluid Dynamics : a clinician's tool for Femoral Artery Stenosis?

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Abstract:Occlusive disease of the femoral artery is a frequent cause of disabling muscle pain during walking and may progress to non-healing skin ulcers of the foot and leg. The underlying disease process, atherosclerosis, is related to the shearing stress of blood on the vessel wall. One way to assess blood's motion near the vessel wall is by computational fluid dynamics (CFD), in which the governing equations of blood flow are solved by numerical techniques. The application of CFD in clinical decision making has thus far been limited mainly to coronary artery stenosis. This thesis presents translational work to assess the potential use of CFD in the diagnosis and treatment of femoral artery stenosis. Two applications are investigated: (1) quantification of the pressure drop over tandem stenoses of varying shapes, and (2) the prediction of stent thrombolization in the Viabahn covered stentgraft in patient-specific geometries. The SimVascular finite element solver was used with CTA-based flow geometries and duplex ultrasound derived boundary conditions. Validation of the simulations in a femoral bifurcation with and without an upstream 75\% stenosis demonstrated velocity fields that matched well with experimental flow visualization for the majority of the cycle, with deviations in jet breakdown and flow reversal that need further investigation. Steady flow simulations in serial stenoses of idealized geometries showed a pronounced contribution of stenosis eccentricity, in contrast to an earlier experiment performed at lower Reynolds numbers. The relative rotation of two serial eccentric lesions was additionally shown to augment the pressure drop if it induced strong helical flows. For stent thrombolization, unsteady flow simulations in one retrospective patient case showed a region of low wall shear stress at the inflow region of the stent, while CTA and duplex had shown no abnormalities. Occlusion of the stentgraft was observed half a year later, highlighting the potential ability of CFD to predict stentgraft complications. The results warrant the application of CFD in prospective cohort studies of patients with peripheral artery disease to generate clinical evidence needed for improved decision making.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:33 physics, 44 medicine, 52 mechanical engineering
Programme:Technical Medicine MSc (60033)
Link to this item:http://purl.utwente.nl/essays/74902
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