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Journal of Biomechanics 35 (2002) 415435

ESB Keynote LectureFDublin 2000

An introduction to biouid mechanicsFbasic models and applications


Dieter Liepsch*
Laboratory for Fluid Mechanics and Institute for Biotechnology, University of Applied Sciences, Lothstr 34, 80335 Munich, Germany
Accepted 5 September 2001

Abstract
Cardiovascular disease is the primary cause of morbidity and mortality in the western world. Complex hemodynamics play a
critical role in the development of atherosclerosis and the processes of aging, as well as many other disease processes. Biouid
mechanics play a major role in the cardiovascular system and it is important to understand the forces and movement of blood cells
and whole blood as well as the interaction between blood cells and the vessel wall. Fundamental uid mechanical, which are
important for the understanding of the blood ow in the cardiovascular circulatory system of the human body aspects are presented.
Measurement techniques for model studies such as LDA, ultrasound, and MRI studies will be discussed. Viscosity and ow
behavior changes specically the creation of vortices and ow disturbances can be used to show how medication can inuence ow
behavior. Experiments have shown that hemodynamics may have a strong inuence on the creation of aneurysms and varicose
veins. Other factors such as vessel wall structure are also important. In preliminary studies, it has been demonstrated that geometry
and elasticity of vessel walls help determine ow behavior. High velocity uctuations indicate ow disturbances that should be
avoided. Health care practitioners must understand uid dynamic factors such as ow rate ratio, pressure and velocity gradients,
and ow behavior, velocity distribution, shear stress on the wall and on blood cells. These mechanical factors are largely responsible
for the deposit of blood cells and lipids, a leading cause of atherosclerosis. The interaction between blood cells and of the cells with
the vessel, leads to the formation of plaques and agglomerations. These deposits are found predominantly at arterial bends and
bifurcations where blood ow is disturbed, where a secondary ow is created, and where ow separation regions are found.
Experiments on hemodynamic eects in elastic silicon rubber models of the cardiovascular system with ow wire, stents, or patches
for vessel surgery will be discussed. These studies can be important in improving diagnostics and therapeutic applications. r 2002
Published by Elsevier Science Ltd.
Keywords: Biouid mechanics; Hemodynamics; Flow visualization; Velocity measurements; LDFA and PIV measurements; Blood vessels; Elastic
models; Steady and pulsatile ow non-Newtonian ow behavior

1. Introduction
Biouid mechanics describe the kinematics and
dynamics of body uids in humans, animals and plants.
We distinguish between external ow around bodies as
in bird ight or the airow around bodies in air
conditioning situation, and internal ow through bodies
such as blood ow through blood vessels.
Hemodynamics deals with body uids in humans.
Classical hemodynamics deals with in vivo and in vitro
measurements of pressure, ow and resistance. Modern
biouid mechanics measures and analyzes local timedependent velocities and ow in blood vessels, the
respiratory system, the lymphatic system and the
*Fax: +49-89-1265-1502.
E-mail address: liepsch@rz.fh-muenchen.de (D. Liepsch).
0021-9290/02/$ - see front matter r 2002 Published by Elsevier Science Ltd.
PII: S 0 0 2 1 - 9 2 9 0 ( 0 1 ) 0 0 1 8 5 - 3

microcirculation (Hosoda et al., 1994; Mosoro et al.,


1989; Kerber and Liepsch, 1994; Stein, 1981).
Biouid mechanic factors must be taken into consideration in clinical areas such as end-to-end and endto-side anastomoses; articial heart, organ and vessel
development; urological measurements and articial
urethra; shock wave treatment of kidney stones; blood
rheology; mass and material transport through membranes, wave spreading, diusion processes, and the
inuence of airow around bodies. To investigate all
these processes, it is important to do model experiments.
Models have many advantages compared to in vivo and
in vitro experiments; most importantly, the experiments
are reproducible. Individual ow parameters, such as
geometry, non-Newtonian ow characteristics, wall
elasticity, steady and pulsatile ow can be studied
individually. Practical applications include testing of

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D. Liepsch / Journal of Biomechanics 35 (2002) 415435

Fig. 1. Schematic of the experimental setup.

Fig. 2. Viscosity versus shear rate for a human blood sample at 371C
compared with the test uid at 211C.

catheter techniques and stents, and training for stent


implantation.
The most important application of biouid mechanics
is in research into atherosclerosis and aging (Caro, 1981;
Chien, 1988; Liepsch et al., 1981; Liepsch, 1990;
.
Naumann and Schmid-Schonbein,
1984; Niimi, 1979;
Stehbens, 1993; Texon, 1980; Yamaguchi and Hanai,

1990; Yoshida et al., 1988). Fundamental studies


analyze the ow parameters mentioned above. Hemodynamics, the consistency and rheology of blood and,
nally, the geometry of the blood vessels all contribute
to atherogenesis.
The entire ow eld in bends and bifurcations must be
measured to obtain exact velocity vectors. At present,
MRI in vivo velocity measurements take far too long,
requiring patients to remain motionless for extended
periods. Color Doppler ultrasound techniques look
promising but the local resolution is still not high
enough. So, model experiments with high spatial and
temporal resolution techniques such as laser-Doppleranemometry are necessary. We have studied the ow in
various silicon rubber models of the aortic arch with
abdominal aorta and kidney arteries; femoral arteries,
coronary arteries, and carotid artery. From these
detailed macroscopic measurements it is possible to
calculate shear stresses very precisely. Shear stresses act
not only on endothelial cells, but also aect the
intermedia. Particles and blood cells in re-circulation
zones must be investigated more closely. Normally, they
do not remain inside ow separation areas for long

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

periods, however, a few particles or an agglomeration of


particles, occasionally rotate over several periods in
these zones, as visualized with our photoelasticity
apparatus with a birefringent solution.

2. Flow parameters and experimental methods


Many scientists have studied the ow behavior in
bends and bifurcations; however, most studies have been
done in rigid or simplied models (Karino and Goldsmith, 1977, 1979; Ku and Giddens, 1983; Palmen,
1994). An overview is given in Zheng et al. (1992).
We used true-to-scale, 1:1 models, so that the
geometry of both pathological and healthy blood vessels
was correct (Liepsch et al., 1992). The following ow
parameters were studied: geometry, steady/unsteady
ow, viscosity, and elasticity of the vessel wall. Our
study methods were: (1) ow visualization using dyes
and photoelasticity apparatus with birefringent solutions (Liepsch et al., 1989); (2) laser sheet techniques; (3)
pressure measurements of the pressure drop with
inductive ow meters; and (4) velocity measurements
with a high spatial and temporal resolution laserDoppler-anemometer (Durst et al., 1976; Liepsch,
1988, 1990; Liepsch et al., 1993). In addition to the
LDA, a particle image velocimeter with the pulsed
Doppler ultrasound and MRI was also used for
comparison measurements in vivo (Allgayer et al.,
1985; Boesiger, 1985; Botnar et al., 1996).

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The ow was measured with inductive ow meters.


The viscosity of the model uid, a polyacrylamide
aqueous solution, was controlled with a low shear
viscometer (Liepsch et al., 1991). The Reynolds and
Strouhal number in the model experiment were the same
as that found in vivo (Liepsch, 1986).
Fig. 1 is a schematic presentation of the experimental
setup for laser-Doppler-anemometer measurements. The
numbers in parentheses below refer to this gure. The
uid is forced from a pressure tank with compressed air
into a reservoir (3). From there it ows into an overow
container (4). To maintain a constant static pressure in
the model, overow uid ows back into the liquid
container (1). The uid streams through the model (6)
and ow meters with small regulation ow tanks (8)
back into the liquid container (1). The regulation ow
tanks can be raised or lowered and the ow rate ratio
(dierent Reynolds number) can be simulated without
wave reections caused by valves. The average ow over
time per pulse period was also measured by weighing
and measuring the time. The uid is transported from
the liquid container over a backow into the pressure
tank. From here the uid is pressed with a compressor
into the reservoir (3). A computer-driven piston pump
(14) superimposes an oscillatory pulse on the steady ow
creating pulsatile ow. The piston stroke can be changed
by computer, creating various pulse waveforms and
ow. To avoid pressure shocks caused by piston, a
buer tank (7) is installed in front of the model as a
lter. The temporal ow was measured with inductive

Fig. 3. Pressure and velocity curve versus time in the common carotid artery model.

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ow meters and the pressure drop was measured with


inductive pressure transducers.

3. Model uids
To simulate the ow characteristics of blood, a blood
analog was developed which has a refraction index
identical to that of the model wall. The uid consists of
51% by weight aqueous Dimethylsulfoxide into which
various polyacrylamides are added (0.0035% Separan
AP-302 and 0.0025% AP-45, Dow Chemical). The
rheological behavior of this uid is nearly identical to
that of blood with a hematocrit of 46%. Fig. 2 (top)
compares the viscosity over the shear rate of the model
uid at 211C with the values for human blood, with
hematocrits of 46% and 42% at 371C. Fig. 2 (middle
and bottom) compares the viscous Z0 and elastic Z00
component (complex viscosity) over the frequency for
the same uids with a maximum deformation of 101 in a
rotating viscosimeter CV 100/RV 100 from Haake. The
viscosity of the model uid and the blood samples were
measured at the respective temperatures with this
viscosimeter. The density of the mixture was equal to
1050 kg/m3 of that of blood.
The representative viscosity, the representative shear
rate and the corresponding ow volume for various
Reynolds numbers were calculated using the measured
viscosity curve and shear gradient.

external carotid arteries. In addition to ow visualization techniques with dyes and a birefringent solution
with a photoelasticity apparatus, the velocity distribution was measured with a 3-D LDA system (Liepsch
et al., 1998). These measurements were also compared
with ultrasound catheter measurements (Liepsch et al.,
1995). Further details are described in Liepsch et al.
(1998). The ow, pressure and velocity curve used for
the experiments is shown in Fig. 3. The average
Reynolds number over a pulse cycle in all models
without stenosis was Re 250: In the stenosed models,
the Reynolds number decreased to Re 180 under
identical experimental conditions. Large velocity uctuations with vortices were found in the stenosed model.
These high frequency velocity uctuations can lead to a
hammer eect at the wall, causing damage over time.
This might be one cause of aneurysm development.
Fig. 4 shows the velocity distribution at several crosssections at steady ow for the non-Newtonian blood

4. Applications
4.1. Carotid artery models
The geometry and inuence of the bifurcation angle
(27491) between the internal and external carotid
arteries has been studied extensively (Liepsch et al.,
1998). It is important to remember that these two
branches do not normally lie in one plane. The spatial
situation is important and must be considered. The
bifurcation angle inuences ow separation. With larger
bifurcation angles, the ow separation regions extend
slightly. However, these dierences in the ow behavior
are small compared with the ow changes in carotid
arteries that have a stenosis in either the internal or
external artery, which causes ow rate ratio changes.
Pulsatile ow was studied in elastic silicon-rubber
carotid artery models using a non-Newtonian, bloodlike uid under physiological conditions. The experimental setup of the circulatory simulator and the
preparation of the models is described in Liepsch
(1989). Models included replicas of healthy human
carotid arteries with varying bifurcation angles, a model
with a 90% internal carotid artery (ICA) stenosis and a
model with 80% stenoses in both the internal and

Fig. 4. Velocity distribution at dierent measured planes in a healthy


carotid artery model with a bifurcation angle between the ECA and
ICA of 371. The ow in the common carotid artery CCA was Re
250: The ow was steady with a ow rate ratio of the ICA to ECA of
70:30. The uid is a non-Newtonian Dimethylsulfoxidepolyacrylamide water solution.

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

analog. The paraboloid becomes atter in the center


because of the low shear rate in the center. The
dierences are very small (about 45%). These
dierences however, are more pronounced just downstream of the bifurcation, where ow separation regions
are found. (See plane 2.5 and 5 mm distal to the
bifurcation.) Index 0W2 stands for the wall opposite the apex, or the outer wall. (See schematic
sketch at the bottom of Fig. 4. The number 1 stands
for ICA.)
The ow divides at the apex; 70% of the ow goes
into the ICA and 30% into the external carotid artery

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(ECA). The ow divider causes a ow disturbance. The


velocity is higher at the inner wall, or at the side of the
apex. On the outer wall side, opposite to the apex, the
velocity is almost zero. Farther downstream, the velocity
drops to zero. Small negative velocities may also be
found. This means that a small ow separation zone is
created on the opposite side of the wall. Farther
downstream, the maximum velocity moves slowly back
towards the center of the vessel. Similar ow conditions
are found in the ECA. In addition to these small ow
separations, a secondary ow is also created. This is
typical for bends and bifurcations.

Fig. 5. Velocity distribution at dierent phases of the pulse cycle for a healthy carotid artery model. The ow in the CCA was Re 250: The
measured plane is 15 mm proximal to the bifurcation.

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We repeated the same experiment in the common


carotid artery 15 mm proximal to the bifurcation,
under pulsatile ow conditions (Fig. 5). Dierent phases
of the pulse cycle from 01 to 1051 are shown. The ow in
the common carotid artery was Re 250: The Womersley parameter was a 3:9 equivalent to a pulse rate
of 60 pulses per minute; the viscosity n 4:5 m2/s and
the radius of the common carotid artery was
d 3:3 mm. Again the attened paraboloid can be
observed. This is typical for blood in larger arteries
er the whole pulse cycle. No backward ow can
be seen. The ow is always directed forward. During
the systolic phase, the ow increases (the maxi-

mum is at phase otB601) and then gradually


decreases.
Fig. 6 shows the velocity distribution for several
phases over the pulse at the apex 0 mm in the ICA.
Fig. 7 shows the velocity distribution over the cross
section at the same position as a colored distribution.
The negative velocities at the outer wall (AW here) in
black/blue can be clearly seen at phase ot 901: In
Fig. 8, the horizontal and vertical components are
shown as secondary ow at the same position. The
development of the secondary ow during the pulse
cycle is clearly demonstrated. The strongest movements
are at phase ot 601:

Fig. 6. Velocity distribution at dierent phases of the pulse cycle for a healthy carotid artery model same as in Fig. 5 however the measured plane is
at the apex 0 mm in the ICA.

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

Fig. 7. As Fig. 6 however as a colored velocity distribution.

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Fig. 8. Secondary ow at the cross section 0 mm in the ICA.

As shown in Figs. 68, the velocity components were


measured in the axial, vertical and horizontal directions.
Fig. 9 shows the velocity distribution 10 mm distal to the
apex in the ICA. The ow was Re 250 and the
Womersley parameter aE3:85: Over one pulse cycle
starting at the systolic phase ot 601; a vortex forms in
the separation zone. This can be clearly seen in Fig. 9a.
It slowly disappears over time during the diastolic phase.
The vortex moves farther downstream because a small
forward ow still exists.
The vertical velocity component clearly indicates a
secondary ow that is created during the systolic phase

ot 451: A double helical ow is formed. This


secondary ow disappears slowly during the diastolic
phase. This secondary ow is created periodically with
the pulse during the systolic phase. The secondary
ow becomes stronger with higher ow. In obtaining
the exact ow vector the third (horizontal) velocity
component (Fig. 9c) must not be neglected during the
phases ot 6021051: Precise calculation of the
shear stresses can be done only with all three velocity
vectors.
If the same experiment is repeated in a model with a
constriction of 90% in the ICA, the ow drops to Re

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

180 in the CCA. The ow rate ratio changes to 56% in


the ICA and 44% in the ECA branches because of the
higher resistance in the ICA. Fig. 10ac shows the axial,
vertical, and horizontal velocity components 10 mm
distal to the bifurcation in the ICA for several phases of
the pulse cycle. This position is directly distal to the
stenosis. Again, higher velocities are found at the inner
side, however the ow is totally disturbed over the whole
cross section. High velocity uctuations are found with
frequencies up to 6080 Hz, especially during the systolic
phase. During the diastolic phase the ow calms,
however negative velocities are found over nearly

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three-quarters of the whole cross section. These nally


disappear at phase otE3301: A secondary ow can be
seen. The values are higher compared to the healthy
model, however the secondary ow is not characteristic
as in the healthy carotid artery model, because the
velocity uctuations in all ow directions are dominant.
These velocity uctuations can also be seen in the
horizontal component. These velocity uctuations create chaotic ow behavior with high and low shear
stresses even if the Re number is low. A jet-like ow is
created in the stenosis with high velocities (4 m/s).
10 mm downstream, distal to the stenosis, high velocity

Fig. 9. Velocity component in the axial (a), vertical (b) and horizontal (c) direction for dierent phase ot of the pulse cycle 10 mm distal to the
bifurcation in the ICA. The ow was Re 250 in the CCA.

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Fig. 9 (Continued )

uctuations are observed. Further details are described


in Liepsch et al. (1998). Particle motion was also studied
in the stenosed ICA and shows similar results (Cao and
Rittgers, 1998). The ow was increased to Re 350 to
create a high blood pressure condition and the experiments were repeated (Liepsch et al., 1998). The ow
disturbances and the velocity uctuations were more
pronounced.
Some important conclusions can be drawn from these
experiments. With increasing bifurcation angle, ow
separation regions in both the ECA and ICA increase
slightly. High blood pressure leads to an increase in ow
separation and to higher velocity shear gradients. An
ICA stenosis with a 90% constriction creates very high
velocity uctuations. The highest shear stresses are
about 20 times higher than normal. Downstream of the
stenosis, eddies are formed. In these separation zones,
particles stick easily to the wall and to existing stenoses.
Sharp edged stenoses will grow faster; smooth stenoses
are not so dangerous (Zimmer, 1982).

Under physiological conditions, the ow has a strong


inuence on the formation and creation of stenosis. As
long as the ow moves forward without creating
negative velocities, no problems arise. Vortices formed
in the branches move forward slowly, with the pulse
wave. However, if negative velocities are created,
indicating the presence of ow separation regions, the
shear gradient between the forward and backward ow
in these regions is high and creates high shear stresses
close to a low shear stress region where particles or cells
adhere to the wall.
Studies have also been carried out in coronary artery
and femoral artery bifurcation models. The tendency is
always the same. The ow moves undisturbed as long as
the bifurcation angle is small or the diameter ratio and
ow rate ratio are small. The ow rate ratio is very
important. The model and measurement techniques
used for these experiments are also useful to test surgical
or diagnostic procedures. Some applications are mentioned below.

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

425

Fig. 9 (Continued )

5. Patches in carotid arteries


Plastic patches are used in vessel surgery to restore an
area from which a stenosis has been removed. The sizes
of these patches vary. Three dierent types, similar in
length, but dierent in width or positioning were
studied. The patches were stitched into a vessel removed
at autopsy. A 1:1 true-to-scale silicon rubber model was
prepared from this vessel. The procedure has been
described several times (Liepsch et al., 1992). Flow
visualization studies with dyes demonstrated that in the
narrower model, the dye ows smoothly without any
ow disturbances. In the wider model, however, the ow
is disturbed, as indicated by the widening dye path. The
patch positioned to the side shows smaller disturbances

than the wide patch. Under pulsatile ow conditions,


similar results were found.
Ideally, the patch should not alter the size of the
vessel. The wider patch, however, creates an abnormal
geometry, which, in turn, creates ow disturbances
leading to clotting or closure of the vessel. The wider
patch creates additional vortices, which aect the vessel
wall and change the ow conditions, eventually creating
a new stenosis or other problems. The velocity distribution over one cross section at dierent phases of the
pulse shows clearly the dierences between the healthy
and the three patch models (Fig. 11). The velocity
vectors (secondary ow) also demonstrate that the
narrower patch causes milder velocity disturbances than
the other patch models. Insertion of a patch should

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D. Liepsch / Journal of Biomechanics 35 (2002) 415435

Fig. 9 (Continued )

create a geometry that comes close to the original


biological conguration. The material that is used
should also be considered carefully (Leonard et al.,
1987).

6. End-to-end, end-to-side anastomoses


The amount and nature of ow disturbance created
by an anastomosis depends largely on the vessel in
which the anastomosis is done. Additional ow disturbances are created by end-to-end anastomoses
(Maurer et al., 1979). Flow studies in stenosed models
and in models with patches of the arteria profunda
femoralis showed that the highly disturbed ow in the
stenosed areas could be restored with a profunda plastic.

If a total femoralissupercialis blockage exists, the


dead-end branch should be excised to avoid vortices.
Otherwise, problems arise in the dead-end branch with
the dead end where high vortices exist. If these are not
removed, agglomerations will arise in this dead area
(Wagner and Kubiena, 1979; Wagner et al., 1979).
End-to-side anastomoses with smaller rather than
larger bifurcation angles are better. Physicians should be
aware that in addition to the stitching procedure,
attention must be paid to the diameter of the
anastomosis. The diameter should be always slightly
smaller or the same size as the original vessel, never
larger. Larger diameters create additional ow disturbances with eddies which in turn lead to stenosis.
Similar results were found in BresciaCimino stulas.
The smoothest ow behavior was seen with the

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

427

Fig. 9 (Continued )

end-to-end anastomosis. End-to-side anastomoses with


a blunt angle also showed good ow behavior (Pugbeil
et al., 1994).

7. Arteriovenous stulas
Several arteriovenous stula models with lengths of
0.5, 1.0 and 2.0 cm were prepared for distal bypass
operation. The elastic silicon rubber models were
prepared from original polytetrauorethylene (PTFE)
grafts of 6 mm diameter. High velocity uctuations and
vortices were found in small stula models. The 2 cm
common ostium stula resulted in a smooth ow pattern
(Maurer et al., 1992, Veith, 1992). Laser vibrometer
studies in the arteriovenous stulas of the carotid artery

in rabbits showed velocity uctuations with surprisingly


high frequencies up to 2000 Hz in rabbits, in human
about 500 Hz (Stehbens et al., 1995). These high
velocity uctuations can damage the wall. They may
be considered a hammer eect and may be one cause of
aneurysms.

8. Aneurysms, stents and veins


Many ow studies have been done in rigid and elastic
models with aneurysms (Kerber et al., 1996; Liepsch
et al., 1987; Steiger et al., 1989; Ujiie et al., 1994). While
the wall structure must be considered in any study of the
genesis of aneurysm, the ow probably has the greatest
inuence. Current considerations include how to

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D. Liepsch / Journal of Biomechanics 35 (2002) 415435

Fig. 9 (Continued )

determine which aneurysms will grow and rupture and


which will not. These questions play an important
role in determining a course of therapy or surgery.
The forces caused by the ow inuence all these
factors.
Dierent types of stents were tested in the carotid
artery models. Stent 1 was a Schneider wall stent with a
diameter of 7 mm and the length was shortened from 25
to 15 mm. The stent was placed completely in the ICA.
Stent 2 was a 15 mm long Schneider wall stent with a
6 mm diameter, which was placed to extend from the
ICA into the bulbus of the carotid artery, covering the
ECA branch. Stent 3 was a Schneider wall stent, 9 mm in
diameter and 25 mm long which was implanted in the
CCa, extending into the ICA.

Fig. 12 shows the positions of the stents. The velocity


distribution at phase ot 601 close to the peak systolic
velocity, as shown in Fig. 13 for all three stents
compared with a healthy carotid artery model without
stent. The measured cross section was 5 mm distal to the
apex in the ICA. Stent 3 shows the best velocity
distribution whereas Stents 1 and 2 create velocity
disturbances.
The position and structure of the stent strongly
inuences the ow. Again, the physician should be
careful to position the stent so that no additional or only
slight ow disturbances are caused. Normally in a
healthy model, a ow separation zone is created at the
beginning of the diastolic phase in the ECA, (phase
ot 9021201). It is larger than in the ICA because the

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

ow is lower. The ow separation region disappears and


moves, in the form of loose vortices, downstream. After
insertion of the stent, this ow separation region
becomes much smaller and exists over a shorter period
of time (pulse cycle ot 901), because the grid of the
stent reduces the ow separation and has a dampening
eect. The woven wire causes only slight ow disturbances. Distal to the stent, small vortices are
observed which fade quickly. Models were also used to
study the high-pressure dilatation of multi-link stents
(Voelker et al., 1997).
Flow studies have also been done in 1:1 true-to-scale
varicose veins (Schalin, 1986). These experiments
showed the inuence of ow from arteriovenous
communications on the vessel wall. Sometimes during
the systolic phase, a jet-like ow from the arterial
venous shunt hits the vein wall on the opposite side of
the shunt. The forces from the jet onto the wall are up to

429

10 times higher than normal and may, over a longer


period, damage the vein wall at this point causing the
varicosity.

9. Ultrasound catheters
Tests have been conducted in stenosed models to
determine whether the insertion of an ultrasound
catheter may provide the physicians with false information or with information that may be incorrectly
interpreted. Ultrasound catheters are used to measure
the blood velocity in vivo in the coronary or femoral
artery. Previous experiments with older catheter designs
showed dierences of >50% of the velocity (Liepsch
et al., 1995). Newer catheters are smaller in diameter
(0.34 mm). A smaller design improves the accuracy of
the signal, however the inuence of the catheter can still

Fig. 10. Same as Fig. 9ac, for a 90% stenosis in the ICA. The ow dropped to ReE180 and the ow rate ratio ICA to ECA 5644%.

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D. Liepsch / Journal of Biomechanics 35 (2002) 415435

Fig. 10 (Continued )

be seen in undisturbed ow regions (straight vessels). No


dierences are present in the stenosis because the
velocity distribution over the cross section is almost
the same. At present, ultrasound is a good tool for
velocity measurements, however attention must be paid
to the positioning of the catheter. The catheter tip (end
of the transducer) is very small and may move towards
the vessel wall providing physicians with incorrect
information e.g. a much lower velocity is recorded than
actually exists. Because LDA has a much higher spatial
and local resolution and observing even small areas, a
comparison of ultrasound spectra analysis with LDA
measurements is important (Kaluzynski et al., 1997).
These experiments showed that better interpretation of
ultrasound signals is possible if the exact velocity
distribution is measured with an LDA. The data

obtained with a catheter are very helpful for physicians


(Yang et al., 1978).

10. Numerical studies


It is also possible to use the fundamental equations
for computational uid dynamics. Numerical results
come very close to physiological ow conditions if the
boundary conditions are known. Scientists (Perktold
and Liepsch, 1994; Perktold and Rappitsch, 1995;
Yamaguchi and Hanai, 1990) now use numerical
programs to simulate ow behavior. This is done, for
example, with nite element methods. In such studies, it
is important that the geometry is precisely reproduced.
With modern laser and computer techniques, a precise

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

431

Fig. 10 (Continued )

reproduction of the vessel can be achieved. Although it


will be many years before a complete and accurate
simulation of the complexities of the human circulation
system can be fully demonstrated by computer, current
studies are promising.

11. Conclusions
Velocity distribution and the hemodynamic forces
acting on the vessel wall and blood cells are very
important. Normally under physiological ow conditions, the ow is neither fully developed laminar ow
nor turbulent ow. It can be described as laminar ow
with periodically returning vortices. These vortices are

created at the beginning of the diastolic phase. Flow


separation regions form only in specic areas of the
circulatory systems i.e. at bends and bifurcations
especially in the carotid artery. Signicantly, these areas
are also the areas where atherogenesis takes place (Caro,
1981; Hosoda et al., 1994; Schettler et al., 1983; Texon,
1980; Yoshida et al., 1988; Stehbens, 1993). Flow
separation regions exist for a short time and for a
specic phase range of the pulse cycle. In rigid models,
these ows separation regions remain over the whole
pulse cycle. As long as the vessel remains elastic, there is
no danger.
The non-Newtonian behavior of blood in low shear
regions also minimizes the danger of large re-circulation
zones. With Newtonian uids, the re-circulation zone

432
D. Liepsch / Journal of Biomechanics 35 (2002) 415435

Fig. 11. Axial velocity components, a comparison of a healthy carotid artery model with a wide and a small patch plastic for the ICA.

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

433

Fig. 12. Schematic of the three dierent stent positions.

Fig. 13. Velocity distribution 5 mm distal to the apex in the ICA for
three stents compared with a healthy ICA model.

extends almost into the center of the cross section. With


a non-Newtonian uid, the re-circulation zone exists
only along a certain distance close to the wall. In vessel
surgery, it is crucial to avoid geometry changes that may
result in large velocity disturbances. This can be
determined by studying the ow eld before and after
surgical alteration in physiologically correct models. An
experimental setup allowing the visualization and
measurement of various ow parameters should be

present in hospitals as standard equipment for testing


and training physicians for catheter placement, ultrasound and MRI measurements, for the testing of
articial devices such as heart valves, stents, and
patches, and for practicing various surgical procedures.
The methods described here can also be used for other
physiological uids e.g. in the urethra or in the lungs. A
complete understanding of uid dynamic fundamentals
is of utmost importance for physicians dealing with
cardiovascular system disorders. Physicians and clinical
personnel must be trained in these fundamentals.
Complications leading to impairment or death could
be avoided if the inuence of ow were clearly understood and correctly applied.
It is time to expand beyond fundamental studies in
wall elasticity and non-Newtonian uids and to
concentrate on the clinical applications of cardiovascular uid dynamics. Future studies should include the
physicochemical and rheological mechanism of atherogenesis. Factors of atherosclerosis such as blood
viscosity at dierent LDLHDL-concentrations
.
(Schmid-Schonbein
et al., 1981), smoking and air
pollution can be studied systematically in models. Fluid
dynamics can also be used to evaluate the reaction and
inuence of medications. Viscosity and ow behavior
changes, specically the creation of vortices and ows
disturbances, can be used to show how medication can
inuence ow behavior. Experiments have shown that
hemodynamics may have a strong inuence on the
creation of aneurysms and varicose veins. Other factors

434

D. Liepsch / Journal of Biomechanics 35 (2002) 415435

such as vessel wall structure are also important.


Geometry and elasticity of vessels walls play an
important role in determining ow behavior. It is
important the clinicians understand that high velocity
uctuations are an indication for ow disturbances that
should be avoided.

Acknowledgements
Some of the studies were made possible by the
support of the Deutsche Forschungsgemeinschaft under
contract Li 256/1-42. Thanks are due to the many
doctoral candidates who helped with the experiments.
Thanks also to Joyce McLean for discussions and
editorial support.

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