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Jayaveera Pandian M1+, Kanan Pujara 2+, Ravishankar L N 3+

A Computational Fluid Dynamics (CFD) study on a high pressure saline jet introduced into the blood for thrombectomy applications is presented here. Numerical simulations were performed using the commercial code ANSYS FLUENT 12. Saline-blood interaction characteristics were simulated assuming steady state, 2D axisymmetric, turbulent and multispecies approach. The diffusivity of saline in blood and the non-Newtonian nature of blood viscosity (Non-Newtonian power law approach) were also incorporated in the simulation. The ultimate aim is to gain an insight about the blood entrainment into the jet and local shear characteristics due to saline jet-blood interaction. In this regard, the variation of pressure, velocity, blood/saline concentrations, strain rates and the radial jet extents at various axial locations were studied. It is observed from the simulations that decay in core axial velocity has a significant impact on the possibility of blood entrainment into the jet. Also, after exiting the nozzle, the flow evolves into a top-hat velocity profile which is consistent with available literature about free jets.

KEYWORDS: Thrombectomy, Endovascular cutting device, CFD, Minimally invasive devices, Biotechnology, Blood flow simulation, liquid-in-liquid

+Contributed equally

Assistant Manager, CFD Larsen & Toubro, IES, Bangalore, India Full list of authors information is provided in the end of the article

Thrombectomy is one of the emergency surgical treatments for the removal of thrombi (blood clots) from blood vessel to restore blood circulation to the affected part and avoiding permanent occlusion of blood flow which leads to necrosis. In this technique, a tiny, flexible tube called as catheter is inserted into a blood vessel through a small surgical hole. A radio-opaque dye is inserted through the catheter to visualize the blockage in the blood vessel through x-ray images. A high pressure fluid, here saline, is injected into the blood medium to create a vacuum which removes the clot. This technique is most often used to treat aneurysms in the brain. The treatment reduces the risk that the blood vessel will break open (rupture). In this study, a catheter inserted into the blood vessel is modeled. Saline is pumped at a very high pressure through a nozzle located at the end of the catheter to form a very high velocity jet. As the saline jet passes through the blood vessels, a vacuum is produced due to the high velocity. If the concentration of clot in blood is less, then this technique proves to be very effective. However, in this technology a large amount of research and development effort is being made to reduce the blood aspiration and explore its applications and associated medical science and it is still under flux. The present work is to understand the blood entrainment into the jet and local shear characteristics due to jet-blood interaction. In this regard the variation of pressure, velocity, blood/saline concentrations, strain rates and the radial jet diameter extents at various axial locations were studied.

The major governing equations used to form the CFD model and the boundary conditions for the simulation study are given below. 2.1 Governing equations The species transport model of ANSYS FLUENT 12.0 has been selected to simulate the present flow. It involves mixing and transport of two miscible speciessaline and blood, by solving the flow conservation equations of continuity, momentum, species and turbulence parameters which describes convection and diffusion sources for each component species. For the flow involving species, conservation equations for the mixture fraction and its variance is solved. Additional transport equations are solved when the flow is turbulent. The Mass Conservation Equation For any flow problems, the conservation equation for continuity should be satisfied foremost. The 2D axisymmetric continuity equation has a form, + + =0 Where x is the axial coordinate, r is the radial coordinate, vx is the axial velocity, vr is the radial velocity and is the volume-weighted density.

The Momentum Conservation Equation Further, the conservation equation for momentum has to be solved to determine the velocity values. The 2D axisymmetric axial momentum equation has the form, 1 1 + + 1 2 1 = + 2 + + 3 Where, = + +

is the mass weighted dynamic viscosity; p is the static pressure; vx and vr is the axial and radial velocities respectively. Species Transport Equation For species transport problems, the conservation equations for species predict the local mass fraction of each species (Yi) through the solution of a convection-diffusion equation for the ith species. The conservation equation takes the form: + = Where is the diffusion flux of species i, which arises due to gradients of concentration. The species conservation equation is solved for all the (n-1) species present in the system (in this case, saline). Since the mass fraction of the species must sum to unity, mass fraction of nth species is determined as one minus the sum of the (n-1) solved mass fractions. To minimize numerical error, the nth species should be selected as that species with the overall largest mass fraction, such as blood in the present problem. For turbulent flows, diffusion flux is computed as
= , +

Where, Sct is the turbulent Schmidt number ( , where t is the turbulent viscosity and Dt is

the turbulent diffusivity.) The default Sct is 0.7. The turbulent diffusion generally overwhelms laminar diffusion, and the specification of detailed laminar diffusion properties in turbulent flows is generally not necessary.

The transport equations for the turbulence kinetic energy k and dissipation rate are solved, and shared by the phases throughout the field. In this work, realizable k- model is considered.

Transport Equations for the Realizable k- Model The mathematical model for turbulent kinetic energy k is given by + = + + And for dissipation rate , + = + +

Where, = is the turbulent viscosity (C =0.09), Gk is the generation of turbulent kinetic energy due to mean velocity gradients, i represents the velocities in the xi coordinate directions, C ,C1 and C2 are constants. k and the turbulent Prandtl numbers for k and respectively. The value of the constants are taken as C1 =1.44, C2 =1.9, k =1and =1.2 For density calculation, the volume fraction of two fluids in a cell is been calculated. Hence volume-weighted average method is used for density to find percentage volume of fluid occupied by a cell. It is computed by dividing the summation of the product of the selected field variable (here density) and cell volume by the total volume of the cell zone. 1 = | |

For viscosity calculation, mass-weighted average method is used. It is computed by dividing the summation of the product of density, cell volume, and the selected field variable by the summation of the product of density and cell volume. | | = | | 2.2 Boundary conditions and solution methodology The geometry of the computational domain with boundary conditions is shown in Figure 1. A pure saline-jet is considered as a steady turbulent flow, which passes through a tiny nozzle, which is at the end of catheter, as it enters the blood domain. Only the upper half of the domain is solved here as the jet is considered to be axisymmetric and hence axis boundary condition is applied along the axis of the domain. The computational domain extracted is shown as below. The CFD calculation starts from 1 mm of upstream of the nozzle exit to 5mm downstream of the nozzle exit. Simulations were performed for domain with 1 mm and 10 mm upstream of nozzle exit. Both the simulations showed very little variation in the results. Hence 1 mm upstream of nozzle exit was considered. At the catheter inlet saline is injected.

Figure 1 Material Properties Saline with density 1000 kg/m3 and dynamic viscosity 0.001Ns/m2 is considered. The mass diffusivity of saline in blood is considered as 0.12 x 10-9 m2/s Blood is modeled as a Non-Newtonian fluid [1] since its viscosity is proportional to shear rate and is very critical. For non-Newtonian fluids, the shear stress can be written in form of non-Newtonian viscosity as, = Where, is defined by, = +

. In general, is a function of all the three invariants of rate-of-deformation tensor However in the non-Newtonian models available in FLUENT, is a function of shear and is defined as rate only. is related to the second invariant of =

To model blood with non-Newtonian properties, ANSYS Fluent provides two options a. Power law b. Carreau model of pseudo-plastics Here, the non-Newtonian Power law model is used to solve for blood viscosity. Power Law for Non-Newtonian Viscosity The non-Newtonian viscosity for the Power law model is calculated as

= Where k, n, To, min and max are input parameters. k is a measure of the average viscosity of the fluid (the consistency index); n is a measure of the deviation of the fluid from Newtonian (the power-law index), as described below; To is the reference temperature and min and max are the lower and upper limits respectively of nonNewtonian viscosity used in the power law. If the viscosity computed from the power law is less than min, the value of min will be used instead. Similarly, if the value of the computed viscosity is greater than max, the value of max will be used.

= The upper and lower limits are placed the power law function which is as below

The following table shows how viscosity is limited by min and max at low and high shear stress rates in this model. The class of fluid is hence determined by the value of n. Power law index ,n Consistency index, k (kg-s^n-2/m) Reference temperature, K Minimum viscosity limit, min (kg/m-s) Maximum viscosity limit, max (kg/m-s) Table 1 n = 1; Newtonian fluid n > 1; shear-thickening (dilatant fluid) n < 1; shear-thinning (pseudo-plastics) The values of k and n used in this study were obtained from the data of shear rate vs. Shear stress [4] A pressure inlet condition of 5kpsi and 1mm Hg has been applied on the saline inlet and blood inlet respectively. Further, mass fraction of blood is set to zero at the saline inlet. The outlet is defined as a pressure outlet open to atmospheric pressure. Turbulence is modeled using the realizable k- model. The pressure-velocity coupling is achieved with SIMPLE algorithm. The gradient is solved using the Least Square cell-based method. The spatial discretization method for Pressure is set to Standard while Second Order Upwind method is employed for Momentum, Turbulent Kinetic Energy, Turbulent Dissipation Rate and mass fraction of Saline so as to ensure accuracy of the CFD model. Due to the high pressure at inlet, difficulties were encountered with convergence. The issue was resolved by using First order discretization in the beginning before switching to Second order discretization schemes. Iterations were performed using structured grid and further refinement was done to capture proper gradient across the flow. The grid refinement tests indicated that the flow predictions in the interface region showed high sensitivity towards the grid size. Mesh adaption method in ANSYS Fluent was used to refine the mesh locally and ensure proper density of elements. After the second adaption, the results were independent of the grid size and there was no variation found in the velocity magnitude. For computational efficiency and stability, quadrilateral mesh elements with gradient in the radial direction were used for the axisymmetric model. The region of salineblood interface was fixed based on the iterations performed and relatively fine grid spacing was employed in the axial and radial direction in the interface. The mesh domain was solved using a workstation with 32 GB ram and 8 core processor. The mesh after grid adaption is shown in Figure 2. 0.4851 0.2073 310 0.00125 0.003

Figure 2 The solution was initialized with mass fraction of blood set to unity. The solution was iterated till the residuals dropped below 1e 1e-05 05 levels. Further, the mass flow at outlet and velocity magnitude at nozzle exit was also monitored to e ensure convergence of solution. Also, studies were carried out to ensure mesh independence of results. The mesh was refined in the jet formation region till the variation in axial jet velocity values lues predicted was within acceptable levels. The region adapted is determined based on the extents of the jet predicted by the nominal mesh. After a converged solution was obtained, results were extracted and analyzed which are shown as below.


To get an insight into o the jet characteristics and saline saline-blood blood interaction, various line surfaces were created in the radial direction along the axis. Eight different axial locations were chosen: 1D, 2D, 5D, 8D, 12D, 16D, 20D and 30D, where D is the diameter of the nozzle exit. 3.1 Mesh Independence Study Based on the analysis of velocity contours for nominal mesh, it was determined that the radial al extent of the jet never exceeded 0.8mm. Hence, using region based adaption technique available in ANSYS FLUENT; cells within the radial distance of 1.25mm from the axis were repeatedly adapted and simulated. The velocity variation along the axis was used as the parameter to determine mesh independence of results. Based on the analysis, it was determined that the se second cond adaption ensured mesh independence.

3.2 Axial jet velocity and blood entrainment

Figure 3 The variation in jet velocity along the axis is shown above in Figure 3. 3 It can be observed that as the flow nears the nozzle, it accelerates due to the constriction in area from the upstream to the nozzle. As it passes through the nozzle, a spike in velocity is observed. This may be attributed to the flow separation at the nozzle inlet due to the geometry of the nozzle. After the flow flow exits the nozzle, it maintains a constant core velocity for a certain axial length before it begins to decay.

Figure 4 It can be observed from Figure 4 that the increase in blood entrainment along the axis begins with the decay in core jet velocity. 3.3 Jet Diameter Measurement

Figure 5

The he variation in diameter of the jet at various axial locations and a fitted trend line is shown above in Figure 5. 5 Usually, the diameter of the jet is determined as the radial distance from the axis where the velocity drops to zero. However, in the present case, due to the non-stationary stationary nature of the domain fluid, coupled with liquid-in-liquid liquid nature of the jet, this method of measurement was found to be difficult to implement. Instead, a zero total pressure approach was used. At the different axial locations, the radial distance at which the total pressure drops to a minimum was taken to be the jet extant. The graph also shows that the variation is quadratic in nature. The equation of the fitted curve is also shown. 3.4 Jet velocity variation

Figure 6 The variation of jet velocity in the radial directions at different axial locations is shown above in Figure 6 6. It shows s the development of the jet and the formation of parabolic top hat velocity profile, a characteristic observed in any kind of free jet. 3.5 Mass fraction ion of saline variation

Figure 7 he variation of mass fraction of saline along the radial direction at various axial The locations is plotted above in Figure 7. . It shows the decrease in saline concentration as the jet progresses, indicating increased entrainment of blood.

3.6 Shear stress variation

Figure 8 The variation of shear stress in the radial direction at various axial locations is shown above in Figure 8. . The local shear stress in the fluid was calculated as the product of local molecular viscosity and strain rate. The plots show that the shear stresses are higher near the nozzle exit due to the high velocity of the jet. However, the maximum shear stress is observed at the nozzle inlet due to the sharp corners. As the jet progresses, due to the miscible nature of saline and blood, the velocity of the jet reduces which results in reduced strain rates and in turn, reduced shear stresses.

A CFD analysis of a high pressure saline jet introduced into a domain consisting of blood is carried out and the results have been presented here. It is observed that sharp corners at the nozzle inlet result in loss of pressure and higher shear stresses in this location. The use of an inclined nozzle might help overcome these losses and lead to higher exit velocities. The amount of blood entrainment in the core of the jet is inversely proportional to the core jet velocity. The rate of entrainment is initially initially higher and smooth out as the jet progresses. The shear stresses are higher near the nozzle exit due to the radial velocity gradient (strain rate). As the jet progresses the miscible nature and diffusion of saline into blood damps out the strain rate and nd reduces the shear stresses. Future scope can be to study the e effect of different nozzle geometry parameters para like length of the nozzle, angle of nozzle and diameter of the nozzle. These parameters have a significant impact on the performance or characteristics charac of jet and reduce blood aspiration.

C. Ramakantha Murthy, Center head, Larsen & Toubro-IES Bangalore, India

Author details
1 2

Assistant Manager, CFD, Larsen & Toubro-IES Bangalore, India Design Engineer, CFD, Larsen & Toubro-IES Bangalore, India 3 Design Engineer, CFD, Larsen & Toubro-IES Bangalore, India

Authors Contribution
All authors were involved in the entire analysis that was carried out. All authors read and approved the final manuscript.

Competing Interests The authors declare that they have no competing interests.

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