Optimum Anastomosis Angle of End-to-side Microsurgical Anastomosis for Preventing Future Shear-related Risk of Thrombosis by Computationalmodeling

Overview

Journal Sci Rep

Specialty Science

Date 2024 Oct 29

PMID 39468275

Authors

Patcharaporn Wongchadakul

Apram Jyot

Kongkrit Chaiyasate

Suphalerk Lohasammakul

Affiliations

Soon will be listed here.

Abstract

End-to-side (ETS) microsurgical anastomosis is a powerful technique in microsurgery. It can overcome vessel's diameter discrepancy and preserve the distal blood flow. Optimal angle of the ETS anastomosis has been debated and studied, and is currently limited to animal models. Computational model using Finite Element Analysis (FEA) was used to simulate the models with 45 (model), 90 (model), and 135 (model) ETS anastomosis angles. Flow dynamics including flow velocity and wall shear rate were studied and compared. Maximum flow velocity ranged from the highest to the lowest in model, model, and model, respectively. The velocity in model135 showed fluctuation flow. The maximum wall shear rate and distribution were highest in model and lowest in model. ETS anastomosis angle of 90 degrees provided the most favourable flow dynamics to prevent shear related thrombosis in comparison to ETS anastomosis at 45 and 135 degrees.

References

Gottlieb L, Krieger L . From the reconstructive ladder to the reconstructive elevator. Plast Reconstr Surg. 1994; 93(7):1503-4. DOI: 10.1097/00006534-199406000-00027. View

Suh H, Hong J . The role of reconstructive microsurgery in treating lower-extremity chronic wounds. Int Wound J. 2019; 16(4):951-959. PMC: 7949270. DOI: 10.1111/iwj.13127. View

Broer P, Moellhoff N, Mayer J, Heidekrueger P, Ninkovic M, Ehrl D . Comparison of Outcomes of End-to-End versus End-to-Side Anastomoses in Lower Extremity Free Flap Reconstructions. J Reconstr Microsurg. 2020; 36(6):432-437. DOI: 10.1055/s-0040-1702156. View

Al-Sukhun J, Penttila H, Ashammakhi N . Microvascular stress analysis: Part II. Effects of vascular wall compliance on blood flow at the graft/recipient vessel junction. J Craniofac Surg. 2011; 22(3):883-7. DOI: 10.1097/SCS.0b013e31820f8004. View

Staalsen N, Ulrich M, Winther J, Pedersen E, How T, Nygaard H . The anastomosis angle does change the flow fields at vascular end-to-side anastomoses in vivo. J Vasc Surg. 1995; 21(3):460-71. DOI: 10.1016/s0741-5214(95)70288-1. View

Zoubos A, Seaber A, Urbaniak J . Hemodynamic and histological differences in end-to-side anastomoses. Microsurgery. 1992; 13(4):200-3. DOI: 10.1002/micr.1920130411. View

Leva C, Engstrom K . Flow resistance over technical anastomoses in relation to the angle of distal end-to-side connections. Scand Cardiovasc J. 2003; 37(3):165-71. DOI: 10.1080/cdv.37.3.165.171. View

Staalsen N, Ulrich M, Kim W, Pedersen E, How T, M Hasenkam J . In vivo analysis and three-dimensional visualisation of blood flow patterns at vascular end-to-side anastomoses. Eur J Vasc Endovasc Surg. 1995; 10(2):168-81. DOI: 10.1016/s1078-5884(05)80108-x. View

Zhang L, Moskovitz M, Piscatelli S, Longaker M, Siebert J . Hemodynamic study of different angled end-to-side anastomoses. Microsurgery. 1995; 16(2):114-7. DOI: 10.1002/micr.1920160214. View

10.

Schneider S, Nuschele S, Wixforth A, Gorzelanny C, Alexander-Katz A, Netz R . Shear-induced unfolding triggers adhesion of von Willebrand factor fibers. Proc Natl Acad Sci U S A. 2007; 104(19):7899-903. PMC: 1876544. DOI: 10.1073/pnas.0608422104. View

11.

Casa L, Deaton D, Ku D . Role of high shear rate in thrombosis. J Vasc Surg. 2015; 61(4):1068-80. DOI: 10.1016/j.jvs.2014.12.050. View

12.

Meyer R, Foley J, Harkema S, Sierra A, POTCHEN E . Magnetic resonance measurement of blood flow in peripheral vessels after acute exercise. Magn Reson Imaging. 1993; 11(8):1085-92. DOI: 10.1016/0730-725x(93)90235-6. View

13.

Sorace A, Robbin M, Umphrey H, Abts C, Berry J, Lockhart M . Ultrasound measurement of brachial artery elasticity prior to hemodialysis access placement: a pilot study. J Ultrasound Med. 2012; 31(10):1581-8. PMC: 3462358. DOI: 10.7863/jum.2012.31.10.1581. View

14.

Takashima K, Kitou T, Mori K, Ikeuchi K . Simulation and experimental observation of contact conditions between stents and artery models. Med Eng Phys. 2006; 29(3):326-35. DOI: 10.1016/j.medengphy.2006.04.003. View

15.

Ghalichi F, Deng X, De Champlain A, Douville Y, King M, Guidoin R . Low Reynolds number turbulence modeling of blood flow in arterial stenoses. Biorheology. 1999; 35(4-5):281-94. DOI: 10.1016/s0006-355x(99)80011-0. View

16.

Kwon O, Krishnamoorthy M, Cho Y, Sankovic J, Banerjee R . Effect of blood viscosity on oxygen transport in residual stenosed artery following angioplasty. J Biomech Eng. 2008; 130(1):011003. DOI: 10.1115/1.2838029. View

17.

Wen J, Ho H, Peng L, Yuan D, Zheng T . Effect of Anastomosis Angles on Retrograde Perfusion and Hemodynamics of Hybrid Treatment for Thoracoabdominal Aortic Aneurysm. Ann Vasc Surg. 2021; 79:298-309. DOI: 10.1016/j.avsg.2021.08.009. View

18.

Cho Y, Kensey K . Effects of the non-Newtonian viscosity of blood on flows in a diseased arterial vessel. Part 1: Steady flows. Biorheology. 1991; 28(3-4):241-62. DOI: 10.3233/bir-1991-283-415. View

19.

Mehri R, Mavriplis C, Fenech M . Red blood cell aggregates and their effect on non-Newtonian blood viscosity at low hematocrit in a two-fluid low shear rate microfluidic system. PLoS One. 2018; 13(7):e0199911. PMC: 6053157. DOI: 10.1371/journal.pone.0199911. View

20.

Lorbeer R, Grotz A, Dorr M, Volzke H, Lieb W, Kuhn J . Reference values of vessel diameters, stenosis prevalence, and arterial variations of the lower limb arteries in a male population sample using contrast-enhanced MR angiography. PLoS One. 2018; 13(6):e0197559. PMC: 6010244. DOI: 10.1371/journal.pone.0197559. View