双路搭桥术的移植管直径对血液流动的影响

Influences of Graft Diameter on the Blood Flow in 2-way Bypassing Surgery

移植管直径对搭桥术的长期通畅率具有至关重要的作用。为了弄清楚移植管直径对双路搭桥术中血液流动的具体影响,利用数值仿真的方法对两个股动脉双路搭桥模型中的生理脉动流进行了研究。为便于比较,除移植管直径不同以外,两个模型均采用相同的几何参数来建模。我们将研究直径一小和一大两个模型。两个模型的流动仿真边界条件相同。峰值雷诺数为832.8,Womersley数为6.14。重点分析了下游缝合区流场。对速度场、上下游足尖的压力差、壁面切应力及其梯度、应力波动系数等血流动力学参数的时空分布进行了比较。研究表明,大直径移植管模型下游缝合区的纵向速度和二次流速度较为紊乱,而其足尖下游远端的轴向流动则具有较大而均匀的纵向速度。同时,大移植管模型具有较小的回流、较均匀的壁面切应力、较低的压力、较小的壁面切应力梯度等特点。然而在二次流分布和应力波动系数方面却没有优势。总之,大移植管模型在近壁部分具有更好、更均匀的血流动力学现象,可以有效地避免术后内膜增生和再狭窄的发生和发展。

The graft diameter plays a critically important role in the long-term patency rotes of bypass surgery. To clarify the influence of graft diameter on the blood flows in the femoral 2-way bypass surgery, the physiologically pulsatile flows in two femoral bypass models were simulated with numerical methods. For the sake of comparison, the models were constructed with identical geometry parameters except the different diameters of grafts. Two models with small and large grafts were studied. The boundary conditions for the simulation of blood flow were constant for both models. The maximum Reynolds number was 832.8, and the Womersley number was 6.14. The emphases of results were on the analysis of flow fields in the vicinity of the distal anastomosis. The temporal-spatial distributions of velocity vectors, pressure drop between the proximal and distal toe, wall shear stresses, wall shear stress gradients and oscillating shear index were compared. The present study indicated that femoral artery bypassed with a large graft demonstrated disturbed axial flow and secondary flow at the distal anastomosis while the axial flow at its downstream of toe was featured with larger and more uniform longitudinal velocities. Meanwhile, the large model exhibits less refluences, relatively uniform wall shear stresses, lower pressure and smaller wall shear stress gradients, whereas it does not have any advantages in the distributions of secondary flow and the oscillating shear index. In general, the large model exhibits better and more uniform hemodynamic phenomena near the vessel wall and may be effective in preventing the initiation and development of postoperative intimal hyperplasia and restenosis.