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Quantification of the ilio-femoral arteries tortuosity and data cluster modelling for preoperative examination

Markiewicz Tomasz, Dziekiewicz Miroslaw

Biocybernetics and Biomedical Engineering

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2022

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Vol. 42, no. 4

1123--1136

EN

Detecting spatial tortuosity and atherosclerotic changes of the ilio-femoral arteries are crucial for planning endovascular access. The aim of this study was to find a reliable quantification procedure of arterial lumen and tortuosity to qualify patients for a suitable endovascular procedure. We conducted computed tomographic angiography in 76 patients. All ilio-femoral segments of the arterial tree were visualized using Osirix Dicom Viewer software to help qualify the patients to one of two groups: with possible or non-recommended vascular access. The same tomograms were then analyzed with image processing algorithms to perform ilio-femoral artery segmentation and quantification. We chose a set of arterial tortuosity and lumen measuring methods, such as the modified Gustafson-Kessel clustering algorithm and Support Vector Machine classifier, to automatically classify arterial-tree regions. The two 2D feature spaces were selected with the modified Gustafson-Kessel clusterization to create a combined model to assign around 2/3 cases to the access groups with high specificity (more than 88%) whereas the remaining patients were selected for re-evaluation. We concluded that the novel modification of the Gustafson-Kessel clustering algorithm is more suitable to the highly inseparable data than commonly used approaches. To identify ilio-femoral access limitations, we recommend more complex decision model. This study confirmed high usability of our chosen methodology in the quantitative examination of arteries for endovascular access planning.

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Blood flows in end-to-end arteriovenous fistulas: Unsteady and steady state numerical investigations of three patient-specific cases

Jodko D., Obidowski D., Reorowicz P., Jóźwik K.

Biocybernetics and Biomedical Engineering

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2017

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Vol. 37, no. 3

528--539

EN

The arterio-venous fistula is a widely accepted vascular access for haemodialysis - a treatment for the end-stage renal disease. However, a significant number of complications (stenoses, thromboses, aneurysms) of fistulas can occur, which are related to the geometry of the anastomosis and the local abnormal hemodynamics. Local flow conditions, in particular the wall shear stress (WSS), are thought to affect sensitive endothelial cells on the inner vessel wall, which leads to intimal hyperplasia. This study presents the results obtained from numerical simulations of the blood flow through three patient-specific end-to-end fistulas which were assessed to be more likely dysfunctional than the end-to side ones. Unsteady and comparative steady-state simulations of blood flow were performed in ANSYS CFX. The obtained results show behaviour of the blood, velocity fields, shear strain, vorticity range, blood viscosity changes, a WSS distribution on vessel walls and give information about the flow rate in the veins receiving blood from fistulas. Blood flow animations are attached to the online version of the paper. Numerical methods seem to be the only opportunity to provide complete information on the distribution and range of the WSS for complicated shapes of blood vessels used to fistula creation, however the WSS is strongly dependent on the local geometry and mesh quality. High values of the shear strain, associated with elevated values of shear stress, found in each model, could increase a risk of haemolysis. High shear environment with raised vorticity can result in activation of platelets and further platelet aggregation and thrombosis.

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Simulations of the blood flow in the arterio-venous fistula for haemodialysis

Jodko D., Obidowski D., Reorowicz P., Jóźwik K.

Acta of Bioengineering and Biomechanics

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2014

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Vol. 16, no. 1

69--74

EN

The Ciminio-Brescia arterio-venous fistula is a preferred vascular access for haemodialysis, but it is often associated with the development of vascular complications, due to changes in hemodynamic conditions. Computational fluid dynamics methods were involved to carry out seven simulations of the blood flow through the fistula for the patient specific (geometrical) case and various boundary conditions. The geometrical data, obtained from the angio-computed tomography, were used to create a 3-dimensional CAD model of the fistula. The blood flow patterns, blood velocity and the wall shear stress, thought to play a key role in the development of typical complications (stenoses, thromboses, aneurysms, etc.), have been analyzed in this study. The blood flow is reversed locally downstream the anastomosis (where the artery is connected to the vein) and downstream the stenosis in the cannulated vein. Blood velocity reaches abnormal value in the anastomosis during the systolic phase of the cardiac cycle (2.66 m/s). The wall shear stress changes in this place during a single cycle of the heart operation from 27.9 to 71.3 Pa (average 41.5 Pa). The results are compared with data found in the literature.