Abhishek Sharna Thesis PDF

Effect of Intracranial Pressure and Fluid loading
on the Hemodynamics of a Cerebral Aneurysm
A Thesis Submitted
In Partial Fulfillment of the Requirements
For the Degree of
B. Tech. – M. Tech. (Dual Degree)
by
Abhishek Sharma
(10327033)
to the
DEPARTMENT OF MECHANICAL ENGINEERING
INDIAN INSTITUTE OF TECHNOLOGY KANPUR
JUNE, 2015
ii
iii
Dedicated to my parents and sisters

iv
Acknowledgements
I would like to express my sincere gratitude to my supervisor, Dr. K. Muralidhar for his patience,
motivation, enthusiasm, and immense knowledge in the field of fluid mechanics. I have been
amazingly fortunate to have an advisor who gave me the freedom to explore on my own, and at
the same time the guidance to recover when my steps faltered.
I would also like to acknowledge Dr. M. K. Das for his encouragement and practical
instructions throughout the span of my thesis work and during teaching assistantship duties.
I am grateful to the Department of Mechanical Engineering at IIT Kanpur for providing
me with outstanding technical amenities in computational fluid dynamics laboratory. I am also
thankful to the IIT Kanpur administration for granting exceptional services at my residence.
In addition, I am sincerely indebted to my family members especially my parents and
sisters for their continuous motivation and everlasting support.
Abhishek Sharma
v
Abstract
Blood flows through the arteries and veins, and transports oxygen, carbon dioxide, hormones and
other vital nutrients. The driving force to pump the blood in the blood vessels is the blood pressure
or more precisely blood pressure difference which is provided by the contraction and relaxation of
the heart. A cardiovascular disease named hypertension causes the diastolic and systolic pressure
levels to attain very high values. The effect of intracranial pressure on the flow patterns is analyzed
on a complex patient specific cerebral aneurysm model. Simulations are carried out to compare
the effects of high blood pressure and normal blood pressure conditions. In addition, the effects of
blood pressure are studied for a patient under a rest and exercise conditions. In order to cure the
cerebral aneurysm, the coil embolization method is extensively used by the surgeons. The efficacy
of the coil embolization method is assessed by considering the coils to be isotropic and
homogeneous porous medium. In the present work, Finite Volume Method is implemented in order
to discretize the 3D unsteady governing differential equations. Blood flow is considered laminar,
incompressible and non-Newtonian. Carreau-Yasuda model of flow in a non-Newtonian fluid is
incorporated to capture the shear thinning behavior of blood. To model the porous medium the
extended Darcy model with Forchheimer and Brinkman terms is appended in the Navier-Stokes
equation. Results show that high blood pressure has more damaging effect on the artery walls than
normal blood pressure. During exercise the fluid loading on the walls is higher than for the rest
condition. The particle residence time is observed to be smaller in high blood pressure and exercise
condition it can lead to adverse conditions for blood clotting which is beneficial to combat
atherosclerosis. After the insertion of coils in the aneurysm, the velocity magnitudes, wall shear
stress and vortex strength drastically reduce.
In the analysis of flow patterns the artery walls are assumed to be rigid but in reality, the
artery walls are made up of soft tissues. These tissues are susceptible to deformation when the fluid
loading is applied. The deformation of walls, after the shape of flow domains that will further alter
the forces on the walls. So an elementary analysis of fluid-solid interaction is presented. The
discretization of the governing differential equations is performed using the weighted residual
approach of Galerkin. The finite element method is implemented to obtain the deformation matrix.
Geometries which are considered in this analysis are a straight tube and a tube with a bulge. The
walls of the arteries are mainly constructed of three distinct layers of materials namely tunica
vi
intima, tunica media and tunica adventitia. The three materials possess different moduli of
elasticity. An assumption is assumed that the artery walls can be replaced by an equivalent single
material. A verification for this assumption by comparing the wall deformation of tubes with
multilayers and single equivalent material is presented for identical boundary conditions. The
analysis of steady state wall deformation of straight tube and a tube with a bulge is exhibited. In
addition, numerical simulations for the time varying deformation of walls due to the pulsatile flow
at the inlet for the aforementioned geometries are also presented. Wall deformation considering
the arteries to be an equivalent single material matches the multilayered deformation. Thus the
assumption of replacing the artery wall material by a single material of equivalent modulus of
elasticity is expected to be valid. Analysis of stationary flow in a straight tube with a bulge at the
center suggests that the wall deformation is a maximum in the bulge region. Maximum and
minimum wall deformations are obtained at t  64.8o and t  241.2o respectively for the
pulsatile flow in a straight tube. In the straight tube with a bulge, the maximum and minimum
deformations are achieved at t  68.40 and t  244.8o respectively.

vii
Table of Contents
Certificate ......................................................................................Error! Bookmark not defined.
Acknowledgements .................................................................................................................. iv
Abstract .....................................................................................................................................v
Table of Contents ................................................................................................................... vii
List of Figures.......................................................................................................................... xi
List of Tables ........................................................................................................................ xvii
Nomenclature ...................................................................................................................... xviii
CHAPTER 1 Introduction and Literature Review ...............................................................1
1.1. Hemodynamics .............................................................................................................4
1.2. Classification of Cardiovascular Diseases .....................................................................4
1.3. Disease Diagnosis and Treatment ..................................................................................7
1.4. Hypertension ............................................................................................................... 10
1.5. Literature Review........................................................................................................ 11
1.5.1. Biomechanics....................................................................................................... 13
1.6. Objectives of the Present Work ................................................................................... 14
1.7. Thesis Outline ............................................................................................................. 15
CHAPTER 2 Problem Formulation .................................................................................... 17
2.1. Flow Domains ............................................................................................................. 17
2.1.1. Healthy artery geometry ....................................................................................... 17
2.1.2. Artery geometry with an aneurysm ...................................................................... 18
2.1.3. Patient specific cerebral aneurysm geometry treated with coil embolization ......... 19
2.2. Governing Differential Equations ................................................................................ 20
2.2.1. Clear medium ...................................................................................................... 21

viii
2.2.2. Porous medium .................................................................................................... 21
2.3. Boundary Conditions .................................................................................................. 22
2.3.1. Inlet boundary conditions ..................................................................................... 22
2.3.2. Rest condition ...................................................................................................... 22
2.3.3. Exercise condition ................................................................................................ 23
2.3.4. Outlet boundary conditions .................................................................................. 24
2.3.5. Normal blood pressure condition .......................................................................... 24
2.3.6. High blood pressure condition .............................................................................. 25
2.3.7. Boundary conditions at wall ................................................................................. 26
2.4. Properties of Blood ..................................................................................................... 27
2.5. Biomechanics .............................................................................................................. 29
CHAPTER 3 Solution Methodology .................................................................................... 33
3.1. Discretization .............................................................................................................. 33
3.2. Numerical Algorithm .................................................................................................. 36
3.3. Numerical Solver ........................................................................................................ 37
3.3.1. Code parallelization ............................................................................................. 37
3.4. Flow Parameters ......................................................................................................... 38
3.5. Grid Generation .......................................................................................................... 39
3.6. Validation of FVM Code............................................................................................. 41
3.6.1. Steady flow in a 90o bend tube ............................................................................. 41
3.6.2. Pulsatile unsteady flow in a 90o bend tube ............................................................ 42
3.6.3. Developing flow in a straight tube ........................................................................ 44
3.7. Solution Methodology for Biomechanics .................................................................... 47
3.7.1. Calculation of equivalent elastic modulus ............................................................ 47
3.7.2. Governing differential equations .......................................................................... 48

ix
3.7.3. Discretization ....................................................................................................... 49
3.7.4. 3D Discretization ................................................................................................. 54
3.7.5. Effect of multilayers of the artery wall ................................................................. 56
CHAPTER 4 Flow Patterns in a Healthy Patient Specific Geometry ................................ 59
4.1. Results and Discussion ................................................................................................ 60
CHAPTER 5 Flow Patterns in a Patient with an Aneurysm .............................................. 71
5.1. Vortex Formation inside the Aneurysm Bulge ............................................................. 71
5.3. Relative Particle Residence Time ................................................................................ 73
5.3.1. Quantification of relative particle residence time .................................................. 73
CHAPTER 6 Flow Patterns in an Aneurysm Treated with Coil Embolization ................. 85
CHAPTER 7 Stress Analysis................................................................................................ 95
7.1. Comparison of Deformation between Single Layered and Multilayered Wall Material 95
7.1.1. Deformation of equivalent material ...................................................................... 95
7.1.2. Deformation of a multilayered material ................................................................ 96
7.2. Analysis for Uniform Flow at Inlet .............................................................................. 98
7.2.1. Wall deformation of a straight tube ...................................................................... 98
7.2.2. Iterations to calculate final deformation ............................................................. 100
7.2.3. Wall deformation of a tube with a bulge in center .............................................. 102
7.3. Pulsatile Flow in a Circular Tube .............................................................................. 103
7.4. Pulsatile Flow in a Straight Tube with a Bulge in Center ........................................... 105
CHAPTER 8 Conclusions and Future Work .................................................................... 107
8.1. Pulsatile Flow in a Cerebral Aneurysm ..................................................................... 107
8.2. Stress Analysis .......................................................................................................... 108

x
8.3. Future Work.............................................................................................................. 108
Appendix A ............................................................................................................................ 111
A.1 Pulsatile Flow through a Tube (Womersley Solution)................................................ 111
A.2 Fully Developed Flow through a Tube ...................................................................... 113
References.............................................................................................................................. 115
xi
List of Figures
Figure 1.1: (a) Depiction of all four circulations of circulatory system via block diagram and (b)
detailed view of circulatory system [www.wikipedia.org/]. In the left side oxygen rich blood is
being circulated to the tissues. In the right side deoxygenated blood is brought back to the heart. 3
Figure 1.2: (a) Diagram depicting restriction to the blood flow due to the Atherosclerosis
[ww.wikimedia.org/] (b) graphical demonstration of saccular and fusiform aneurysms
[http://www.barnesjewish.org/] and (c) cerebral aneurysm [www.upload.wikimedia.org]. ...........6
Figure 1.3: (a) Angioplasty treatment [www.drbcshah.com] (b) Atherectomy [hearthealth.aha-
krames.com] (c) open surgical repair [www.lienkabothaandpartners.co.za] (d) aneurysm clipping
treatment [www.barnesjewish.org] and (e) coil embolization [www.acsneuro.com]. ...................9
Figure 2.1: Patient specific healthy artery geometry considered for simulations. Arrow indicates
the direction of blood flow. ....................................................................................................... 17
Figure 2.2: Geometry of patient specific artery with a cerebral aneurysm near the bend considered
for the simulations. .................................................................................................................... 18
Figure 2.3: Patient specific artery geometry after coil embolization treatment. Darker grey color
denotes clear medium. Lighter grey color specifies porous medium. ......................................... 19
Figure 2.4: A schematic depiction of representative elementary volume of porous medium. ...... 20
Figure 2.5: Time varying inlet mean velocity waveform profile for a patient at rest. .................. 22
Figure 2.6: Time varying inlet mean velocity waveform profile for exercise conditions. Time
averaged Reynolds number is 500. ............................................................................................ 23
Figure 2.7: Time varying normal blood pressure waveform profiles for a patient at rest and under
exercise conditions. ................................................................................................................... 25
Figure 2.8: Time varying high blood pressure waveform profiles for a patient at rest and under
exercise conditions. ................................................................................................................... 26
Figure 2.9: Variation of blood viscosity with respect to shear strain rate (  ) for the formulation
given by Carreau Yashuda model. ............................................................................................. 28
Figure 2.10: Zoomed in view of an artery wall demonstrating three distinct layers of materials
having different elastic modulus. ............................................................................................... 29
xii
Figure 2.11: Cross-section of the tube with the boundary conditions. Wall pressure is being exerted
in the radial outward direction. Wall shear stress is along axial direction. .................................. 30
Figure 2.12: Pipe geometry considered for the analysis of wall deformation. ............................. 31
Figure 2.13: Straight pipe geometry with a bulge in center. Analysis for this geometry is analogous
to the wall deformation in an artery with an aneurysm. .............................................................. 31
Figure 3.1: A unit tetrahedral cell used in unstructured meshing of flow domains. ..................... 34
Figure 3.2: Tetrahedral meshes at the inlet plane, the aneurysm cross-section and the outer surface
near the aneurysm. Mesh is progressively refined to the walls while maintaining its quality. ..... 40
Figure 3.3: Geometry of a circular tube with a 90 o bend considered for validation. Inlet length to
diameter ratio is 62.5 and the exit length to diameter ratio is 12.5. ............................................. 41
Figure 3.4: Validation of finite volume simulator of fluid flowing in a tube with a right-angled
bend. Secondary flow in the bend is shown at three Reynolds numbers (300, 600 and 1200). First
row is experimental data recorded by a laser induced fluorescence technique (Timité et al. (2010)),
second row is obtained from the numerical simulation. Overall flow field is steady. .................. 42
Figure 3.5: Cross-sectional view of the tube at the exit of the bend ............................................ 43
Figure 3.6: Validation of the numerical simulator against experiments for pulsatile flow in a tube
with a bend. Selected phases of oscillation are considered. Re = 600,

Wo =12.14. Coordinates x
and y are defined in the cross-sectional plane of the tube. .......................................................... 44

Figure 3.7: Non-dimensional velocity variation with non-dimensional radial position. .............. 45
Figure 3.8: Pressure variation along axial direction. .................................................................. 46
Figure 3.9: Schematic depiction of normal and shear stresses in Cartesian coordinates .............. 48
Figure 3.10: Two dimensional cross-section of a pipe. Wall pressure and wall shear stress are
exerted at the inner surface of the tube. Wall pressure is along the radially outward direction and
wall shear stress is in the axial direction. ................................................................................... 49
Figure 3.11: Demonstration of triangular meshing of the considered domain. Lower plot showcases
zoomed in view of the meshes. .................................................................................................. 50
Figure 3.12: Triangular meshing of two distinct materials. Node i is shared by material 1 and
material 2. ................................................................................................................................. 57
Figure 4.1: Three dimensional cross-section plane on which the velocity contours are plotted. .. 60
xiii
Figure 4.2: Spatial variation of time averaged and mean removed RMS dimensionless velocity,
wall pressure and wall shear stress in a healthy artery. Results are shown for normal blood pressure
under rest conditions. ................................................................................................................ 63
Figure 4.3: Spatial variation of the instantaneous distribution of dimensionless velocity, wall
pressure and wall shear stress in a healthy artery for normal blood pressure at rest conditions. Phase
‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an instant corresponding to
minimum velocity that follows phase ‘a’. .................................................................................. 64
wall pressure and wall shear stress in a healthy artery. Results are shown for high blood pressure
under rest conditions. ................................................................................................................ 65
pressure and wall shear stress in a healthy artery for high blood pressure at rest conditions. Phase
minimum velocity that follows phase ‘a’. .................................................................................. 66
under exercise conditions. ......................................................................................................... 67
pressure and wall shear stress in a healthy artery for normal blood pressure under exercise
conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an instant
corresponding to minimum velocity that follows phase ‘a’. ....................................................... 68
under exercise conditions. ......................................................................................................... 69
pressure and wall shear stress in a healthy artery for high blood pressure under exercise conditions.
Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an instant corresponding
to minimum velocity that follows phase ‘a’. .............................................................................. 70
Figure 5.1: Three dimensional stream traces of the time averaged flow field formed in a patient
specific artery in the presence of an aneurysm. Two views of streamtraces clearly reveal vortex
formation in the bulge of the artery. .......................................................................................... 71
xiv
Figure 5.2: Particle motion in patient specific artery with aneurysm. Particles were released at the
same point in the two geometries. Left figure is for a patient with normal blood pressure under rest
conditions. The right figure is for a patient with high blood pressure under exercise conditions. 75
Figure 5.3: Relative particle residence time contours across the bulge cross-section. The left figure
is under rest condition for a patient with normal BP. The right figure is for exercise conditions
when the patient has high BP..................................................................................................... 75
wall pressure and wall shear stress in a patient with an aneurysm. The results are shown for normal
blood pressure in a patient at rest. .............................................................................................. 76
pressure and wall shear stress in a patient with an aneurysm for normal blood pressure at rest
wall pressure and wall shear stress in a patient with an aneurysm. The results are shown for high
blood pressure in a patient at rest. .............................................................................................. 78
pressure and wall shear stress in a patient with an aneurysm for high blood pressure at rest
blood pressure under exercise conditions. .................................................................................. 80
pressure and wall shear stress in a patient with an aneurysm for normal blood pressure under
exercise conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an
instant corresponding to minimum velocity that follows phase ‘a’. ............................................ 81
blood pressure under exercise conditions. .................................................................................. 82
xv
pressure and wall shear stress in a patient with an aneurysm for high blood pressure under exercise
Figure 6.1: Stream traces of the time averaged flow in a patient after coil embolization. The
elimination of recirculation vortex in the bulge is clearly revealed by the three dimensional plot.
................................................................................................................................................. 85
wall pressure and wall shear stress in a patient after coil embolization treatment. The results are
shown for normal blood pressure in a patient at rest. ................................................................. 87
pressure and wall shear stress in a patient after coil embolization treatment for normal blood
pressure at rest conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’
is an instant corresponding to minimum velocity that follows phase ‘a’. .................................... 88
shown for high blood pressure in a patient at rest. ..................................................................... 89
pressure and wall shear stress in a patient after coil embolization treatment for high blood pressure
at rest conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an
instant corresponding to minimum velocity that follows phase ‘a’. ............................................ 90
shown for normal blood pressure under exercise conditions. ..................................................... 91
pressure under exercise conditions. Phase ‘a’ is time instant when inflow velocity is maximum.
Phase ‘b’ is an instant corresponding to minimum velocity that follows phase ‘a’. .................... 92
shown for high blood pressure under exercise conditions. ......................................................... 93
xvi
under exercise conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’
is an instant corresponding to minimum velocity that follows phase ‘a’. .................................... 94
Figure 7.1: Deformation of a straight tube due to uniform loading at inner surface. ................... 95
Figure 7.2: Deformation of a tube due to uniform loading at inner surface. The tube material is
comprised of three distinct layers of materials. .......................................................................... 96
Figure 7.3: Comparison of wall deformation of a tube between multilayered and single equivalent
layered material. Multilayered material has three distinct layers of materials and in single layered
analysis the artery walls are replaced by an equivalent single material. ...................................... 97
Figure 7.4: Variation of wall pressure with respect to axial position for uniform flow at inlet. ... 98
Figure 7.5: Variation of wall shear stress with respect to axial position for uniform flow. .......... 99
Figure 7.6: Variation of modified pressure along axial direction for deformed geometry. ........ 100
Figure 7.7: Comparison of deformed geometry of a straight tube with original undeformed
geometry for uniform flow at inlet. .......................................................................................... 101
Figure 7.8: Spatial variation of velocity, wall pressure and wall shear stress in original and
deformed geometry. ................................................................................................................ 101
Figure 7.9: Variation of pressure at the wall and centerline with respect to axial position for
uniform flow at the inflow plane. ............................................................................................ 102
Figure 7.10: Graphical comparison between the deformed geometry of a tube with a bulge in center
and the original undeformed geometry for uniform flow at inlet. ............................................. 103
Figure 7.11: Pressure variation along axial direction at selected phases of time for 10 th cycle of
oscillation. .............................................................................................................................. 104
Figure 7.12: Wall shear stress variation along axial direction at various timesteps. .................. 104
Figure 7.13: Deformation of a straight tube for pulsatile flow at inlet. The deformations are shown
at selected time instants for 10th cycle of oscillation. ............................................................... 105
Figure 7.14: Pressure variation along axial direction at selected phases of time for 10 th cycle of
oscillation. .............................................................................................................................. 106
Figure 7.15: Deformed straight tube with a bulge in center for pulsatile flow at inlet. The results
are shown at selected time instants for 10th cycle of oscillation. ............................................... 106
xvii
List of Tables
Table 2.1: Listing of dividing terms to generate non-dimensional parameters. ........................... 21

Table 3.1: Description of parameters used in generalized equation. ........................................... 34
Table 3.2: Description of parameters used in Equation (3.2). ..................................................... 35
Table 3.3: Description of parameters used in Equation (3.3). ..................................................... 35
Table 3.4: Description of flow parameters. ................................................................................ 38
Table 3.5: Details of meshing parameters for the geometries considered in this analysis. ........... 39
Table 3.6: Data table for three different materials of arterial walls. ............................................ 47
Table 4.1: Sequence of cases presented in the next few chapters. ............................................... 59
Table 4.2: Peak variation of flow parameters at the outer wall near the bend. ............................ 62
Table 5.1: Peak variation of flow parameters in the aneurysm bulge. ......................................... 75
Table 6.1: Peak variation of flow parameters in the bulge treated with coil embolization. .......... 86
xviii
Nomenclature
Symbols
 Porosity
 Exchange coefficient
 Normal direction to surface
 Dynamic viscosity (Pa-s)
 Kinematic viscosity (m2/s)
 Poisson’s ratio
 Density (kg/m3)
 Angular frequency of waveform (Hz)
 Stress (N/m2)
 Strain
 Shear strain rate (s-1)
E Modulus of elasticity (Pa)
 Shear stress (N/m2)
Coefficients used in derivations

iRe n ; Clear medium

An  
i Re n  Da ; Porous medium
 Gn
 i ; Clear medium
 n
Bn   Re Gn
 
;
 i Re n  Porous medium
 Da
Cf Inertia coefficient
D Diameter of bulge (m)
d Inlet diameter of tube (m)
Da Darcy number ( K / d 2 )
xix
f Frequency of oscillations (Hz)

Ik Modified Bessel’s function of kth order
K Permeability (m2)
m Relaxation time (s)
M1 Coefficient of Darcy term
M2 Coefficient of Forchheimer term
N Shape function
p Intrinsic phase average pressure (Pa)
R Radius of tube at inlet (m)
 U ref d 
Re Reynolds number  
  
t Time (s)
t Thickness in biomechanics (m)
T Time period of oscillations (s)
u x component of velocity, displacement in x direction (m/s)
U ref Time-averaged mean velocity at inlet (m/s)
v y component of velocity, displacement in y direction (m/s)
V  
Velocity vector uiˆ  vjˆ  wkˆ (m/s)
V* Dimensionless velocity vector

w z component of velocity, displacement in z direction (m/s)
W Weighted residual function
 
Wo Womersley number  R 
  
WSS Wall shear stress (N/m2)
i Represents ith direction
n Harmonic
xx
CHAPTER 1 Introduction and Literature Review
The circulatory system is responsible for transporting vital materials throughout the body. It
transports nutrients, water and oxygen to our billions of body cells and carries away wastes such
as carbon dioxide that body cells produce. In an artistic manner, it can be assumed as a highway
that travels through our entire body connecting all our body cells. The major parts of circulatory
system are the heart, blood and blood vessels. Blood comprises plasma, red blood cells, white
blood cells and platelets. The classification of blood vessels can be done in the form of arteries
capillaries, arterioles, venules and veins. Arteries carry the oxygen rich blood from heart to the
different parts of bodies to fulfill the requirement of the oxygen. Veins bring the oxygen deficient
blood back to the heart. Capillaries connect arteries and veins to each other. The extension of
arteries up to capillaries is known as arterioles; similarly the intermediate region of veins and
capillaries is called venules.
The circulatory system is essentially made up of two closed circuit systems, first is the
cardiovascular system which includes the distribution of blood and the second is lymphatic system
which circulates lymph. These two systems are independent of each other and the passage of lymph
takes a lot longer than that of blood. Blood is a fluid consisting of plasma, red blood cells, white
blood cells and platelets that is circulated by the heart through the vertebrate vascular system,
carrying oxygen and nutrients to and waste materials away from all body tissues. Lymph is
essentially recycled excess blood plasma after it has been filtered from the interstitial fluid
(between cells) and returned to the lymphatic system. The cardiovascular system can be studied in
three major circulations which are as follows:
(i) Pulmonary circulation: Under the pulmonary circulation, in simple words the deoxygenated
blood is carried away from the heart to the lungs and the oxygen rich blood is brought back to
the heart. The contraction of the right atrium ejects carbon dioxide rich and oxygen deficient
blood through the tricuspid valve into the right ventricle. Contraction of the right ventricle
pumps the blood through the pulmonic valve (also called semilunar valve) into the pulmonary
arteries. These arteries bifurcate and transport blood into the complex network of pulmonary
capillaries in the lungs. During respiratory inhalation, the concentration of oxygen in the air is
higher than in the capillary blood. Oxygen diffuses across capillary walls into blood.
Simultaneously, the concentration of carbon dioxide in the blood is higher than in air and
carbon dioxide diffuses from the blood into the alveoli. Carbon dioxide exits through the mouth
and nostrils. Oxygenated blood leaves the lungs through the pulmonary veins and enters the
left atrium. When the left atrium contracts, it pumps blood through the bicuspid (mitral) valve
into the left ventricle. Blood then flows through systematic circulation.
(ii) Systematic circulation: The systemic circulation is the circulation of the blood to all parts of
the body except the lungs. Systemic circulation is the portion of the cardiovascular system
which transports oxygenated blood away from the heart through the aorta from the left
ventricle where the blood has been previously deposited from pulmonary circulation, to the
rest of the body, and returns oxygen-depleted blood back to the heart. The contraction of the
left ventricle of the heart pumps oxygen-rich blood to a relatively high pressure and ejects it
through the aortic valve into the aorta. Branches from the aorta supply blood to the various
organs via systemic arteries and arterioles. These, in turn, carry blood to the capillaries in the
tissues of various organs. Oxygen and nutrients are transported by diffusion across the walls
of the capillaries to the tissues. Cellular metabolism in the tissues generates carbon dioxide and
byproducts (waste). Carbon dioxide dissolves in blood and waste is carried by the blood
stream. Blood drains into venules and veins. These vessels ultimately empty into two large
veins called the superior vena cava and inferior vena cava that return carbon dioxide rich blood
to the right atrium. The mean pressure falls continuously as blood moves farther from the heart.
The highest pressure in the vessels of the circulatory system is in the aorta and in the systemic
arteries while the lowest pressure is in the venae cavae.
(iii)Coronary circulation: In coronary circulation, blood is supplied to and from the heart muscle
itself. The vessels that supply blood with a high concentration of oxygen to the myocardium
are known as coronary arteries. Blood flows through the coronary arteries of the heart and
returns through the cardiac veins which remove the deoxygenated blood from the heart muscle.
The coronary arteries that run on the surface of the heart are relatively narrow vessels and are
commonly affected by atherosclerosis and can become blocked, causing angina or a heart
attack.
(iv) Cerebral circulation: Cerebral circulation is the movement of blood through the network of
blood vessels supplying the brain. The arteries deliver oxygenated blood, glucose and other
nutrients to the brain and the veins carry deoxygenated blood back to the heart, removing
carbon dioxide, lactic acid, and other metabolic products.
2
(a)
(b)
Figure 1.1: (a) Depiction of all four circulations of circulatory system via block diagram and (b)
detailed view of circulatory system [www.wikipedia.org/]. In the left side oxygen rich blood is
being circulated to the tissues. In the right side deoxygenated blood is brought back to the heart.
3
1.1. Hemodynamics
Hemodynamics or blood dynamics is the study of the properties and flow of blood. Adequate blood
circulation is a necessary condition for ample supply of oxygen to all tissues which, in turn is
associated with cardiovascular health, survival of surgical patients, longevity and quality of life.
To an outside observer such as a physician or a nurse these hemodynamic forces demonstrate
themselves as blood pressure and blood flow paired values at different nodes of the cardiovascular
system. Hypertension and congestive heart failure are two best known systemic hemodynamic
disorders. Hemodynamic mainly deals with velocity field and involve several different forms, such
as flow separation, vortex formation, shear stresses, and spatial and temporal shear stress gradients.
Between the blood and vessel wall there is a monolayer of cells called endothelial cells (ECs). Any
interactions enhanced by hemodynamic factors seem to interplay on the ECs first, and
subsequently these actions induce unfavorable cell responses that contribute to wall deformations,
diseases and its progression. The injury hypothesis, which suggests that endothelial cells may be
damaged or become dysfunctional as a result of hemodynamic factors, is widely accepted as the
pathogenesis of atherosclerosis. Local inflammation of the vessel wall is commonly observed,
which further strengthens the injury hypothesis. Much attention has been given to fluid dynamic
wall shear stress which induces a micro environment of interaction between blood and arterial
walls. WSS is a vector whose magnitude is proportional to the blood viscosity and flow velocity
gradient normal to the surface, and which acts in a direction parallel to the local velocity at the
wall. WSS is difficult to measure directly in vivo or in vitro so that it is generally computed from
the local velocity distribution near the wall. Therefore, the investigation of WSS effects requires
knowledge of the local velocity field. Correlations with plaque occurrence have been made for
low, high and oscillating WSSs. WSS distribution, in turn, is highly influenced by diameter
changes, separation zones, recirculation areas, turbulence, and elasticity.
1.2. Classification of Cardiovascular Diseases

Chances of severe cardiovascular diseases due to the abnormality in the flow patterns, are quite
high. An estimated 17.5 million people died from cardiovascular diseases in 2014, which is almost
31% of all global deaths. The risk factors which enhance the propensity of cardiovascular diseases
are hypertension, diabetes, tobacco consumption, and smoking. The cardiovascular diseases are
classified under the categories of coronary heart diseases, cerebrovascular disease, peripheral
arterial disease, rheumatic heart disease, congenital heart disease and deep vein thrombosis and
4
pulmonary embolism. If we discuss the deep root causes of these diseases, then we find that all
these diseases are occurring due to the irregular or misguided behavior of blood flow. Moreover,
blood flow is impaired due to the hindrance in blood vessels, or due to the weakening of the walls,
the weaker walls protrude outside resulting into bulge formation. These diseases are discussed
below.
(i) Atherosclerosis: Atherosclerosis also known as arteriosclerotic vascular disease, is a disease
in which plaque gets deposited on the inner side of blood vessels. This plaque builds up due to
the accumulation of fat, cholesterol, calcium, and other substances found in the blood over a
period of time. Since the arterial walls get thicker, the flow passage or cross-sectional area
through which blood flows, gets narrowed down resulting into abnormality in flow parameters.
(ii) Aneurysm: An aneurysm occurs when part of a blood vessel or cardiac chamber swells, either
the blood vessel is damaged, or there is a weakness in the wall of the blood vessel. As blood
pressure builds up, the arterial wall balloons out at its weakest point. The swelling can be quite
small or very large - when large it tends to extend along the blood vessel. As the aneurysm
grows, there is a greater risk of rupture and this can lead to severe hemorrhage, and other
complications, including sudden death. The major locations for aneurysm to occur, are
abdominal region which are known as Abdominal Aortic Aneurysms and cerebral regimes
known as Cerebral Aneurysms. Cerebral aneurysms can be further divided in saccular
aneurysm, fusiform aneurysm and microaneurysms. Rupture of aneurysm leads to hemorrhage
in the subarachnoid space and sometimes in brain parenchyma. About 60% of patients die
immediately after rupture. Larger aneurysms have a greater tendency to rupture, though most
ruptured aneurysms are less than 10 mm in diameter
In the present study a patient specific cerebral aneurysm model is analyzed for the effects
of intracranial pressure and physiological conditions. The cerebral aneurysm has the dilation of
the order of artery diameter. Cardiovascular diseases and various kinds of aneurysms such as
saccular, fusiform are shown in Figure 1.2.
5
(a)
(b) (c)
Figure 1.2: (a) Diagram depicting restriction to the blood flow due to the Atherosclerosis
[ww.wikimedia.org/] (b) graphical demonstration of saccular and fusiform aneurysms
[http://www.barnesjewish.org/] and (c) cerebral aneurysm [www.upload.wikimedia.org].
6
1.3. Disease Diagnosis and Treatment
Aneurysms are diagnosed with different kind of diagnosis methods. The most popular aneurysm
detection methods are computerized tomography scan (CT scan), magnetic resonance imaging
(MRI), magnetic resonance angiography (MRA), radiography, ultrasonography. Computerized
tomography scan is a specialized X-ray exam, which is usually the first test used to determine
bleeding in the brain. The test produces images that are 2-D slices of the brain. In this test, doctors
inject a particular dye in the arteries that makes it easier to observe blood flow in the brain and
may indicate the site of a ruptured aneurysm. Cerebrospinal fluid test, if there is a subarachnoid
hemorrhage, there will most likely be red blood cells in the fluid surrounding brain and spine
(cerebrospinal fluid). By detecting the cerebrospinal fluids, it can be concluded that there is an
aneurysm in the vicinity of that region. Angiography or magnetic resonance angiography, this
method is generally employed as a preoperative evaluation technique in patients with
atherosclerotic vascular disease. This method leads to better examination of the length of the
aneurysm as catheters that are used to make measurements in this method follow the contours of
the vessels. Radiography, in AAA cases, X-ray images show the calcium deposits on the wall of
the aneurysm. Plain radiographs are accurate in their diagnosis for as many as 90% of their cases.
In case of suspected AAA, X-rays are followed by ultrasound and CT scans for confirmation.
Ultrasonography uses high-frequency sound (ultrasound) waves to produce images of internal
organs and other tissues. A transducer converts electrical current into sound waves, which are sent
into the body’s tissues. Sound waves bounce off structures in the body and are reflected back to
the transducer, which converts the waves into electrical signals. A computer converts the pattern
of electrical signals into an image, which is displayed on a monitor and recorded as a digital
computer image.
In order to treat these diseases various conventional medical therapies are used, in which
they try to eradicate the cause or factor which has adverse impact on the hemodynamics.
(i) Treatment of Atherosclerosis: In the case of severe atherosclerosis, where the blood flow
passage is nearly blocked or narrowed, angioplasty or balloon angioplasty method is used to
widen up the arterial flow cross-section. An empty, collapsed balloon, known as a balloon
catheter, is passed over a wire into the narrowed locations and then inflated to a fixed size. The
balloon forces expansion of the stenosis within the vessel and the surrounding muscular wall,
opening up the blood vessel for improved blood flow, and then the balloon is deflated and
7
withdrawn. One more similar method, Atherectomy is also used to cure atherosclerosis. In this
method a catheter with additional sharp blade is passed to the plaque accumulated zone and
with the help of blade the plaque is removed. Another method is flow bypass which is
commonly used in the case of thin arteries, in which a healthy blood vessel is used to bypass
the blood flow from the blocked artery to healthy artery.
(ii) Treatment of Aneurysms: The most common treatment for a large, unruptured aneurysm is
open surgical repair by a vascular surgeon. This procedure involves a cut from just below the
breastbone to the top of the pubic bone. The surgeon then clamps off the aorta, cuts open the
aneurysm and sews in a graft to act as a bridge for the blood flow. The blood flow then goes
through the plastic graft and no longer allows the direct pulsation pressure of the blood to
further expand the weak aorta wall.
Clipping treatment is also used for the treatment of aneurysm, this process involves a
metal clip which is wrapped around the base of aneurysm to prevent the blood flow inside the
aneurysm bulge, which will ensure that the aneurysm walls no longer face any kind of wall
shear stress and change in blood pressure. However the effect of wall shear stress and forces
exerted by the external clip exhibit effects near the neck of aneurysm that still can cause
rupture.
Endovascular coil embolization is the most prevailing method for the treatment of
cerebral aneurysms. As the cerebral aneurysm region is quite intricate and sensitive to physical
operations, thus the coil embolization treatment due to its minimal invasion nature is more
popular than the methods discussed above. In this treatment process, a catheter is inserted
inside the blood vessel with the help of X-ray images to determine the location of catheter,
once the catheter reaches its desired location around 5 or 6 soft coils are passed through the
catheter to fill up the aneurysm volume. Some aneurysms which have a large neck or base,
require additional stent to hold the coils inside the bulge otherwise the coils may come out and
may block blood flow which result into further severe problem. Due to the insertion of coils,
blood can no longer apply as much wall shear stress on the walls as it was imposing before coil
embolization treatment and the flow velocity inside the aneurysm bulge is also suppressed
significantly. In order to study the effect of coil embolization, the bunch of coils can be treated
as a porous medium with appropriate porosity and permeability. A detailed analysis of coil
embolization treatment is presented in further chapters.
8
(a) (b)
(c) (d)
(e)
Figure 1.3: (a) Angioplasty treatment [www.drbcshah.com] (b) Atherectomy [hearthealth.aha-
krames.com] (c) open surgical repair [www.lienkabothaandpartners.co.za] (d) aneurysm clipping
treatment [www.barnesjewish.org] and (e) coil embolization [www.acsneuro.com].
9
1.4. Hypertension
Blood drives the oxygen and other nutrients by flowing through the arteries and veins. The driving
force to pump the blood in the arteries is the blood pressure gradient. Similar to the water flow in
pipes, water flows from higher pressure regimes to lower pressure regimes, blood also flows from
higher pressure areas to lesser pressure areas. It is the heart which works as a pump and produces
higher pressure domains.
The measurement of blood pressure is performed in systolic and diastolic states. Systolic
blood pressure corresponds to the blood pressure when the heart contracts, whereas diastolic
pressure corresponds to the blood pressure when the heart relaxes or gains its original dimensions.
As far as normal conditions are concerned, a systolic pressure of 120 mmHg (millimeters of
mercury) and a diastolic pressure of 80 mmHg is considered a normal blood pressure condition
which is commonly known as 120 over 80.
In abnormal conditions, elevated levels of blood pressure are observed during the disease
of hypertension. High blood pressure is a condition in which the forces exerted by the blood on
the arterial walls are so high that it can cause severe health issues such as rupture of arteries, heart
strokes and many others. In hypertension, the systolic pressure can showcase the pressure levels
around 180 to 190 mmHg and in some of the worst cases it reaches even at 250 mmHg. High levels
of blood pressure are common in aged people and the risk of becoming high blood pressure patient
in later life can be justified due to aging effects. Several environmental factors also influence blood
pressure. High salt consumption raises the blood pressure in patients who are quite sensitive to
salt, lack of exercise, stress, obesity and depression. Some other factors are also responsible for
high blood pressure condition such as consumption of caffeine, nicotine and lack of vitamin D.
Some of the past events, such as low birth weight, lack of breast feeding and maternal smoking
may cause hypertension in later stages of life. Lifestyle also exhibits a great impact on blood
pressure. Over consumption of alcohol, physical inactivity, smoking, medicines such as birth
control pills and sedentary lifestyle can be blamed for high blood pressure conditions.
During the treatment of aneurysms, doctors highly recommend a tap on blood pressure and
not letting it cross a certain level. During high blood pressure the arterial dimensions are slightly
different than the normal conditions. It can cause development of stresses in the walls after
treatment when the arteries will attain their original shape.
10
1.5. Literature Review
Numerous studies have been carried out in the area of circulation system. Ample amount of
experimental and simulation data is available in the literature to pursue the analysis in the field of
cardiovascular diseases such as aneurysms, coronary infractions and atherosclerosis. Blood flow
is a very interesting area of research as it has direct impact on our health. Most of the literature on
blood flow focuses on the hemodynamics of the arteries, the velocity profile, pressure distribution,
and the shear stress induced at the walls of the artery. Many of the studies are carried out,
considering artery walls to be rigid instead of elastic walls. The use of an elastic model of walls is
essential to attain realistic results.
Here computation fluid dynamics plays a major role in the determination of flow
parameters by giving proper boundary conditions and properties of blood. Various numerical
methods, such as finite element method (FEM), finite difference method (FDM), and finite volume
method (FVM) are used to solve the governing differential equations. In the present study a C++
code is written incorporating the FVM method.
Experiments also have been conducted to analyze the impacts of blood flow in the arteries.
Due to the intricacy of human body and small sized flow domains, these studies have not been a
major success so far. Some of the real life experiments for the analysis of velocity fields, wall
shear stress and pressure distributions in arteries have been carried out by Ku et al. (2004) and
Motomiya et al. (2004). These results have been used by Fernandez et al. (2006) and Perktold et
al. (2011) to verify numerical solutions.
Blood flow simulations in arteries having aneurysm are reported in Khanafer et al. (2006)
and Sheard (2009) predominantly concerning upon the wall shear stress, wall pressure and flow
fields. Byun et al. (2004) numerically studied coil embolization by modeling the coil as a small
solid sphere placed at various locations within the aneurysm. Groden et al. (2001) Studied three
dimensional pulsatile flow in a cerebral aneurysm numerically before and after coil embolization.
The authors used cube-shaped cells to represent the coils. Preliminary studies have also been
carried out treating coil embolization using porous medium models by Vafai (2011). The analysis
of impact of blood pressure on the abdominal aortic aneurysm with fusiform aneurysm has been
performed by Giuma et al. (2009), Abe et al. (2010) and Taib et al. (2009). Subsequently the effect
of pressure on formation of vortex (Taib et al. (2009), Le et al. (2013)) shows that the vortex
strength is adversely related to blood pressure and blood pressure gradient. Similar kind of studies
11
to gauge the effect of blood pressure on wall shear stress and forces exerted on the stented
aneurysm walls (Li et al. (2005), Boussel et al. (2008) and Lantz et al. (2015)) are also conducted.
According to the real life examples, the formation of aneurysms takes place at the bifurcations,
bends and junctions. The determination of location where the aneurysm can be initiated is
dependent upon the behavior of wall shear stress and wall pressure (Boussel et al. (2008), Zhang
et al. (2013)). Detailed studies for fluid-solid interaction are reported in Bazilevs et al. (2006),
Génevaux et al. (2003) and Torii et al. (2008). Torii et al. developed a model of cerebral aneurysm
and performed the finite element analysis and analyzed the deformation of aneurysm walls.
Bazilevs et al. (2010) numerically studied blood flow through the cerebral aneurysm model and
reported the impact of wall shear stress on the rupture of an aneurysm.
In the treatment of aneurysms especially cerebral aneurysm, the coil embolization method
is widely accepted. Modeling of inserted coils can be done in the form of porous medium with
appropriate porosity and permeability. Undoubtedly this method, medically is well accepted. In
order to verify its effect mathematically, numerous studies have been carried out so far. Earlier
studies of porous medium dealt with the Darcy’s law which relates flow velocity linearly to the
pressure gradient. Later developments led to a refined model where two more forcing terms were
added in the momentum equation. The Brinkman term captures the confining boundary effect
while the Forchheimer term accounts for fluid acceleration (Nield et al. (2006)). Later Vafai
(2011), provided an exact solution for steady laminar flow in a porous channel using Forchheimer-
Brinkman extended Darcy model. Haji-Sheikh et al. (2004), used Brinkman extended Darcy model
to analyze steady flow field in various shaped ducts using method of weighted residuals. Morosuk
(2005) and Teamah et al. (2011), studied the entropy change and laminar forced convection in a
pipe fully and partially filled with porous medium using Brinkman extended Darcy equation.
Nazemi et al. (1990), developed a model of plaque formation process in the carotid
bifurcation. In their model, plaque formed where the shear stress values fluctuated from high to
low values. According to their two-dimensional study, plaque deposits appear not only in the
carotid sinus but also in the external carotid and at the divider wall between the sinus and the
internal carotid.
The physiological range of the Reynolds number in the artery is more or less 500 in most
of the cases reported in this study, which is well below the critical Reynolds number (2000 < Re
< 3000). Whether turbulence occurs in the physiological region is still an open question. If
12
turbulence occurs in this physiological range, then it might occur locally or during systole. Under
normal physiological conditions, no turbulence was found for steady flow in the artery by Ku et
al. (2004), whereas, Giddens et al. (1990) pointed out that turbulence can occur when stenosis
reaches a sufficiently high level.
1.5.1. Biomechanics
Blood vessels exhibit elasticity when blood flows through them, although the stress and strain
relationship is not linear. However for preliminary analysis an equivalent modulus of elasticity can
be assumed. Initially when there is almost no fluid loading on the walls, the walls behave as very
soft tissue and gradually when loading enhances on the wall, the elastic modulus surges to high
values. According to Salzar et al. (2005) mechanical stress changes over a model of the carotid,
with the highest stress concentration at the bifurcation and across the sinus bulb. Endothelial cells,
which are situated at the wetted surface of the artery wall, are mechanotransducers, transferring
fluid dynamics stresses imposed by the blood into biochemical signals of the vascular cells. One
theory of signal transduction is that the stiffness of the membrane itself serves as a sensor for wall
shear stress. The blood flow in an artery with two successive bends and the effect of curvature of
the bend was investigated by Hoogstraten et al. (1996). Similar studies were carried out on curved
pipes by Berger et al. (2003). In both the studies, the authors found out that the locations at bends
which corresponds to the elevated WSS are susceptible for the development of atherosclerosis.
Various factors affect the arterial blood flow such as arterial geometry, flow parameters, pulsatile
flow, elasticity of arterial wall, and non-Newtonian behavior of blood. Since the geometry of an
artery is of primary importance in blood flow, several studies have been carried out considering
different geometries.
In order to determine the stiffness of arterial walls various invasive and non-invasive
methods are used. Khamdaeng et al. (2012), reported noninvasive assessment using applanation
tonometry and an in vivo ultrasound-based motion estimation technique. The calculation of
Young’s modulus was carried out using two methods such as linear elastic two-parallel spring
model and a two-dimensional, nonlinear, hyper elastic model. The arterial walls are modeled as a
composite material constituting three materials tunica intima, tunica media and tunica adventitia.
Other than these some other materials are lamellae, elastin–collagen fibers and collagen fibers.
This study suggested that in the initial stage of the elastic modulus exhibits a linear behavior. After
13
a certain point, known as transition point, there is a steep rise in modulus of elasticity. The elastic
modulus for all the materials and fibers, is reported before and after the transition region.
1.6. Objectives of the Present Work

In the present study, blood flow is simulated in a patient specific healthy artery geometry, with an
aneurysm and coil embolization treated geometry. Blood flow is considered as incompressible,
unsteady and non-Newtonian. This entire thesis can be divided in five major sections, as follows:
(1) In order to understand the cause behind the occurrence of cerebral aneurysm, initial
simulations are carried out on a healthy geometry which does not have the aneurysm.
Moreover, it is also discussed that the most prone area for the formation of aneurysm is near
the bend of an artery. The changes which are introduced in flow patterns, wall pressure and
wall shear stress due to the formation of aneurysm bulge are covered.
(2) Human circulatory system undergoes various biological and physical conditions, out of which
two, rest conditions and exercise conditions are examined in this study. During the exercise
condition, there are significant changes in the blood flow patterns at the inlet. Therefore the
study of its impact on health compared to rest is analyzed. The reason behind recommendation
of exercise by doctors is discussed.
(3) Aneurysm formation takes place in later stages of life and one of the root cause is believed to
be hypertension (High Blood Pressure). It is important to analyze the detrimental impact of
hypertension on arteries. A computational comparative analysis of high blood pressure and
normal blood pressure is reported in the current work.
(4) To prevent the growth and eradicate the possibility of aneurysm rupture many treatment
procedures are used. One of the most common method to cure cerebral aneurysm is coil
embolization. To analyze the efficacy of this treatment, in order to curb the propensity of
aneurysm rupture, a detailed analysis is presented.
(5) Since blood flows through the blood vessels, it will exert forces on the wall in terms of wall
pressure and wall shear stress. The walls will deform resulting in a change of shape of flow
domain. That will further change the magnitude of forces exerted on the walls. Thus the shape
of flow domain and forces on the walls are dependent on each other. A study of wall
deformation due to fluid loading is also reported.
14
1.7. Thesis Outline
The present study is divided in eight chapters as follows:
(1) Chapter 1 introduces the current work and the work that has been done in this field by other
researchers.
(2) Chapter 2 presents the mathematical modelling of flow in clear and porous media, geometries
and boundary conditions.
(3) Chapter 3 reports the discretization of governing differential equations for fluid flow and
stress analysis.
(4) Chapter 4, 5 and 6 present the analysis of flow patterns in a healthy artery, in a patient with a
cerebral aneurysm and in a patient treated with coil embolization.
(5) Chapter 7 includes the deformation of walls due to steady and pulsatile flows in a straight tube
and a tube with a bulge in center.
(6) Chapter 8 summarizes major conclusions for fluid flow and stress analysis and provides an
insight for future work.
(7) The appendix is added for the derivation of Womersley velocity profiles used at inlet and the
numerical solution of fully developed flow in a tube.
15
CHAPTER 2 Problem Formulation
Starting with a healthy artery geometry, the effect of fluid loading and blood pressure is to be
analyzed on a geometry with an aneurysm and coil embolization treated patient. In this chapter
flow domains (artery geometries healthy and unhealthy), boundary conditions, flow mediums and
non-Newtonian behavior of blood are discussed. Apart from this, the differential equations of
biomechanics and their boundary conditions are also discussed.
2.1. Flow Domains
Flow patterns are analyzed on a healthy artery geometry followed by a patient with an aneurysm
and after coil embolization treatment.
2.1.1. Healthy artery geometry
There are various internal and external factors which give rise to the formation of an aneurysm.
Simulations help us to determine the internal factors which causes the walls to inflate. In order to
pursue the analysis of occurrence of aneurysm and to determine the probable location for aneurysm
formation, a healthy artery geometry (Figure 2.1) is considered.
Figure 2.1: Patient specific healthy artery geometry considered for simulations. Arrow indicates
the direction of blood flow.
2.1.2. Artery geometry with an aneurysm
A 4.5 mm inlet diameter patient specific cerebral aneurysm geometry model (Figure 2.2) is
considered for this analysis. This geometry is constructed using the magnetic resonance
angiographic images which are feed to the vascular construction tools. This cerebral aneurysm
geometry is the property of CISTIB lab at the Universitat Pompeu Fabra of Barcelona and is
available as open source. Using the GIMIAS and VMTK, two straight tube are added one at the
inlet and another at the outlet to ensure the flow to get fully developed before entering the area of
interest. The diameter of the aneurysm bulge near the bend is of the order of the artery diameter.
Figure 2.2: Geometry of patient specific artery with a cerebral aneurysm near the bend considered
for the simulations.
18
2.1.3. Patient specific cerebral aneurysm geometry treated with coil embolization
The coil embolization treatment is one of the most successful and widely accepted method to cure
cerebral aneurysms. The analysis to estimate the efficacy of coil embolization method is presented
in this study, for that the aneurysm bulge is filled with coils. Mathematically, the coils inserted in
the aneurysm bulge are considered as homogeneous and isotropic porous medium with certain
porosity and permeability. In the below mentioned geometry (Figure 2.3), the darker grey region
indicates clear medium whereas the lighter grey region represents porous medium. Smooth
transition of porous medium from clear medium is ensured to avoid sudden changes in flow
parameters. The values of porosity and permeability have been taken from Kakalis et al. (2008).
Figure 2.3: Patient specific artery geometry after coil embolization treatment. Darker grey color
denotes clear medium. Lighter grey color specifies porous medium.
19
2.2. Governing Differential Equations
Blood flow is considered incompressible, unsteady and laminar throughout the study. In the
present study, governing differential equations are solved for both clear and porous media. Porous
medium comprises of solid and liquid phase, the fluid flows through the pores. Porosity and
permeability are the two parameters which define the porous medium:
(i) Porosity: It is the ratio of the volume of voids to the entire volume of porous medium and
mathematically it is defined as –
Vvoids
 (2.1)
Vtotal
(ii) Permeability: It is a measure which determines how easily the fluid can flow through the
porous medium. The Darcy constant is a number by which the permeability of porous
medium is represented. Here K is permeability and d is characteristic length (diameter).
K
Da  (2.2)
d2
Figure 2.4: A schematic depiction of representative elementary volume of porous medium.

If the porosity of a porous medium is one and permeability is infinity than essentially this
porous medium is a clear medium. Therefore once the discretization of porous medium equations
is accomplished, then substituting porosity equal to one and permeability equal to infinity, will
give the discretized governing differential equations of a clear medium.
20
2.2.1. Clear medium
V  0 (2.3)

 V
 t

 
 V  V   p     V  V T

 (2.4)
2.2.2. Porous medium

V  0 (2.5)
Cf 
  V 1

  t 


1

 
 V  V   p     V  V T   K V  K
VV (2.6)
The description of each symbol is given in the Nomenclature. For a porous medium, V
represents volumetric phase averaged velocity and p represents intrinsic phase averaged pressure.
The continuity equations remains the same for both the media ((2.3) and (2.5)). In the momentum
equation of porous medium, the Darcy and Forchheimer terms are added to capture additional
pressure drops of a porous medium. From the momentum equation of porous medium, it is evident
that if porosity (  ) is one and permeability ( K ) is infinite, then momentum equation for porous
medium will be the same as that of clear medium.
In the non-dimensionalized form the above equations can be represented as:
V *  0 (2.7)
 V * 

 t
 
 V *  V *   p* 

1
Re
 
   V *  V *T  (2.8)
 V * 1 *      Cf * *
  
 V  V *   p* 
1
 
V *  V *T   V*  V V (2.9)
 t   Re    Re Da Da
The non-dimensional terms are obtained by dividing some certain factors. These factors are listed
in the Table 2.1.
Table 2.1: Listing of dividing terms to generate non-dimensional parameters.

Parameter Dividing term Parameter Dividing term
Length Inlet diameter (d) Vorticity U Ref / d
Time-averaged inlet
Velocity Wall shear stress U Ref / d
velocity ( U Ref )
Pressure U Ref
2
Time d / U Ref
21
2.3. Boundary Conditions
All the boundaries are divided in the form of inlet, outlet and walls. Boundary conditions imposed
at these boundaries are elaborated below.
2.3.1. Inlet boundary conditions
At the inlet of the considered geometry, the time varying velocity boundary condition is enforced
as Dirichlet boundary condition and for pressure Neumann boundary condition is used. Since the
inlet of all the geometries are circular in shape, the velocity boundary condition in the form of
Womersley profile is imposed to introduce spatial and time dependent variation. To analyze the
impact of physiological conditions on the rupture of aneurysm, two most common conditions such
as rest and exercise conditions are studied in this research. The details of a patient undergoing rest
and exercise conditions are reported below.
2.3.2. Rest condition
Depending upon the physical condition, when patient is relaxing and not undergoing any strenuous
activity, the blood flow at the inflow plane of the geometry is governed by the rest condition
velocity waveform profile (Figure 2.5). Peak and minimum Reynolds numbers are 723 and 361.
The average Reynolds number is kept around 500. The time period of velocity waveform profile
for rest condition is 0.86 seconds which results into 1.162 Hz natural frequency.
Figure 2.5: Time varying inlet mean velocity waveform profile for a patient at rest.
22
The velocity waveform profile in the form of Fourier series can be represented as:
wavg (t )  0.377678  0.089307 sin(2t )  0.010679 cos(2t ) 
0.041881sin(4t )  0.022294 cos(4t )  0.016702sin(6t ) 
(2.10)
0.04062 cos(6t )  0.008648sin(8t )  0.024070 cos(8t ) 
0.011791sin(10t )  0.016723cos(10t )
where  is the fundamental frequency, corresponding to the time period. (  = 1.162 Hz)
2.3.3. Exercise condition
When the patient undergoes some physical activity, there will be change in inlet velocity waveform
profile. Since the heart is beating faster to provide adequate oxygen supply under exercise
conditions, the peak velocity in the case of exercise condition (Figure 2.6) is higher than that of
rest condition and the time period of exercise condition is 0.45 seconds compared to 0.86 seconds
for resting. Peak and minimum Reynolds numbers are 843 and 277. The time-average Reynolds
number is again kept constant to 500 as the time-averaged blood flow remains the same for a
patient at rest and under exercise conditions. The exercise condition inlet mean velocity profile is
shown below:
Figure 2.6: Time varying inlet mean velocity waveform profile for exercise conditions. Time
averaged Reynolds number is 500.
23
The Fourier series of exercise condition velocity waveform profile is:
wavg (t )  0.415824  0.168193sin(2t )  0.055129 cos(2t ) 
0.002249sin(4t )  0.08681cos(4t )  0.023621sin(6t ) 
(2.11)
0.045132 cos(6t )  0.033581sin(8t )  0.009208cos(8t ) 
0.00888sin(10t )  0.014415cos(10t )
where  is 2.222 Hz.
2.3.4. Outlet boundary conditions

At the outlet time varying and spatially uniform pressure boundary condition is imposed as
Dirichlet boundary condition and for velocity Neumann boundary condition (zero gradient of
velocity in axial direction at outlet) is applied. In order to analyze the impact of intracranial
pressure on the rupture of cerebral aneurysm, two medically proposed situations normal blood
pressure and high blood pressure are examined in this study.
2.3.5. Normal blood pressure condition

When the systolic and diastolic pressure is nearly 120 mmHg and 80 mmHg respectively, this state
of the patient is defined as normal blood pressure. During the course of normal blood pressure,
there are quite lesser chances of heart disease and strokes. The time varying and spatially uniform
normal blood pressure waveform profile which is used in the current analysis is shown in Figure
2.7. The time period of the normal blood pressure waveform will depend upon the heart beat rate.
In other words if the patient is at rest then its time period is taken as 0.86 seconds and under
exercise conditions it is considered as 0.45 seconds. Depending upon the time period, the natural
frequency for rest and exercise conditions will be different.
The Fourier series for pressure waveform profiles are written below:
(t )
prest  86.49054  11.320134sin(21t )  6.354035cos(21t ) 
8.251978sin(41t )  2.530753cos(41t )  6.812429sin(61t ) 
(2.12)
4.11549 cos(61t )  1.206652sin(81t )  1.789398cos(81t ) 
2.871322sin(101t )  1.167639 cos(101t )
24
(t )
pexercise  86.49054  11.320134sin(22t )  6.354035cos(22t ) 
8.251978sin(42t )  2.530753cos(42t )  6.812429sin(62t ) 
(2.13)
4.11549 cos(62t )  1.206652sin(82t )  1.789398cos(82t ) 
2.871322sin(102t )  1.167639 cos(102t )
Here 1  1.162 Hz and 2  2.222 Hz.
Figure 2.7: Time varying normal blood pressure waveform profiles for a patient at rest and under
exercise conditions.
2.3.6. High blood pressure condition

If the values of systolic and diastolic blood pressures exceed the normal blood pressure levels
(120-80 mmHg), this condition is known as hypertension or high blood pressure. Generally the
systolic pressure reaches around 180 mmHg and diastolic pressure touches 120 mmHg pressure
level under high blood pressure condition (Figure 2.8). The pressure Fourier series for rest and
exercise conditions are presented below:
(t )
prest  117.986133  17.106806sin(21t )  9.218812 cos(21t ) 
12.691689sin(41t )  3.092671cos(41t )  9.78207 sin(61t ) 
(2.14)
7.31097 cos(61t )  1.449467 sin(81t )  3.009801cos(81t ) 
3.822816sin(101t )  2.34569 cos(21t )
25
(t )
pexercise  117.986133  17.106806sin(22t )  9.218812 cos(22t ) 
12.691689sin(42t )  3.092671cos(42t )  9.78207 sin(62t ) 
(2.15)
7.31097 cos(62t )  1.449467 sin(82t )  3.009801cos(82t ) 
3.822816sin(102t )  2.34569 cos(102t )
Figure 2.8: Time varying high blood pressure waveform profiles for a patient at rest and under
exercise conditions.
Here in both high blood pressure and normal blood pressure, the frequency in Fourier series
depends upon the inlet condition. For the rest conditions  1 will be equal to 1.162 Hz and for the
case of exercise conditions  2 will be 2.222 Hz.
2.3.7. Boundary conditions at wall

The walls of flow domains are considered as rigid and stationary. At the wall no-slip and no-flow
boundary conditions for velocity are imposed. According to the no-slip condition, the velocity
parallel to the wall will be equal to the wall velocity which is zero as the walls are stationary. Since
the walls are impermeable, no-flow condition suggests that in the normal direction of the wall, the
velocity will be zero. Using the Navier-Stokes equations, the pressure gradient normal to the wall
is assumed to be zero.
26
2.4. Properties of Blood
Blood is an integral part of the circulatory system. It carries nutrients, oxygen and other necessary
substances to the body parts and brings back the carbon dioxide, ammonia and other wastage with
it. It comprises plasma, red blood cells, white blood cells and platelates out of which two major
components are plasma and RBC’s. Red blood cells usually constitutes 40 – 45% of toal blood
volume and 50% of blood volume is made up of plasma. The analysis of blood viscosity is known
as blood rheology. The viscosity of blood is dependent on various factors such as strain rate,
temperature, age. Mainly the change in viscosity (Figure 2.9) is caused by strain rate while the
change in viscosity due to temperature rise, is small.
The primary variables of blood viscosity are blood cell deformability, hematocritre, red
blood cell aggregation, and plasma viscosity. Viscosity of plasma is determined by the amount of
water and macromolecular components. The plasma behaves as a Newtonian fluid but it is the
contribution of RBC’s which make blood a non-Newtonian fluid. An RBC has 40% excess surface
area compared to a sphere of the same volume. This is attributed to the biconcave-disc shape. The
excess surface area allows the RBC to undergo volume preserving deformations, and increases the
surface area available for the gases to diffuse across the semi-permeable membrane. The
relationship between hematocrit and blood viscosity is extremely sensitive. When the hematocrit
reaches 60 or 70% (in the case of polycythemia) the blood viscosity incresses up to 10 times that
of water, and its flow through blood vessels is greatly retarded because of increased resistance to
flow which further result into oxygen flow deficiency.
When the blood flow rate is quite low, RBC’s tend to aggregate, known as Erythrocyte
aggregation which increases the blood viscosity. Erythrocytes aggregate in a special way, forming
rouleaux. Rouleaux are stacks of erythrocytes which form because of the unique discoid shape of
the cells in vertebrate body. The flat surface of the discoid RBCs give them a large surface area to
make contact and stick to each other; thus, forming a rouleau.
Blood is a vigorous medium insofar as it behaves as a non-Newtonian fluid, since its
viscosity changes as a function of shear strain rate. When blood moves quickly as in peak-systole,
it is physically thinner; when it moves slowly during end-diastole, it is thicker and stickier. This is
because red cells aggregate. The phenomenon is known as the shear-thinning, non-Newtonian
behavior of blood.
27
Figure 2.9: Variation of blood viscosity with respect to shear strain rate (  ) for the formulation
given by Carreau Yashuda model.
Various studies, numerical and experimental have been conducted to exactly understand
the behaviour of blood. The multiphase model of blood also has been studied by Boryczko et al.
(2003), in which the dynamics of red blood cells and plasma ewre studied using a discrete particle
approach.
Shear thinning is a phenomenon when viscosity of a fluid decreases with increase in shear strain
rate. All materials which showcase shear thinning behaviour are classified thixotropic. In this study
the Carreau-Yashuda model (Leuprecht et al. (2001)) is implemented to capture the effect of shear
thinning of blood and is given as follows:
0  
 ( )    (2.16)
 
a
1  m n
1  u u 
where    ij ij and  ij   i  j 
2  x j xi
 
In Equation (2.16),  0 is blood viscosity at zero strain rate and similarly   is blood viscosity
at infinite or very high strain rate. Constants ‘m’, ‘n’ and ‘a’ are determined experimentally.
28
2.5. Biomechanics
As we know that the blood vessels are not rigid. Instead they are quite prone to being deformed.
The analysis of deformation of arterial walls due to the blood flow, is essential. The artery walls
are made up of three distinct layers of materials (Figure 2.10) namely tunica intima, tunica media
and tunica adventitia. These materials exhibit different moduli of elasticity.
(i) Tunica intima: The innermost layer, which is in direct contact with the blood, is commonly
known as intima. The intima generally consists of a monolayer of endothelial cells that is
separated from the sub-endothelium by a thin basal lamina.
(ii) Tunica media: The middle layer, which is in-between the intima and adventitia, is called
tunica media. This is the thickest of the three layers. It is made up of smooth muscle cells and
elastic tissues or lamina.
(iii)Tunica adventitia: The outermost layer is known as the tunica adventitia or the adventitia,
and is composed of connective tissues. This is a relatively thin tissue layer. The adventitia of
arteries is comprised of only 10 percent of elastic fibers and mainly consists of thick bundles
of collagenous fibrils.
Figure 2.10: Zoomed in view of an artery wall demonstrating three distinct layers of materials
having different elastic modulus.
29
In order to analyze the deformation of walls, two geometries are considered in this study.
The first geometry (Figure 2.12) is a straight tube with blood flow. The blood is considered non-
Newtonian fluid (2.4) and for that Carreau Yasuda model is used. A uniform blood flow at the
inflow plane is considered in the tube having Reynolds number equal to 500. Wall deformation
due to pulsatile flow at the inlet is also carried out.
In the tube geometry with a bulge at the center (Figure 2.13) developing flow and pulsatile
flow are considered at a Reynolds number of 500 and 200 respectively. The bulge can be assumed
as an abdominal aortic aneurysm mainly found in aorta. Over a period of time calculations of the
deformation are carried out for steady flow. The primary flow parameters such as wall pressure
and wall shear stress are calculated and these parameters are used as traction boundary condition
on the walls of the considered geometry. The new geometry and mesh are constructed based upon
the deformation data and again the flow parameters are calculated till the solution reaches a
convergence limit for deformation. For the pulsatile flow the deformation is calculated at each
timestep with an interval of 0.01 seconds.
The data required for biomechanics calculations such as elastic modulus and thickness of
tunica intima, tunica media and tunica adventitia are acquired from Khamdaeng et al. (2012). The
boundary conditions considered, are as follows:
At the inlet and outlet fixed wall boundary condition is imposed. At the inlet and outlet the
displacements of the nodes in all directions are zero. At the inner surface which is in direct contact
with blood, two traction boundary conditions are enforced. First is normal to the wall surface being
caused by wall pressure exerted by fluid and the second is parallel to the blood flow direction
caused by wall shear stress.
Figure 2.11: Cross-section of the tube with the boundary conditions. Wall pressure is being exerted
in the radial outward direction. Wall shear stress is along axial direction.
30
Figure 2.12: Pipe geometry considered for the analysis of wall deformation.
Figure 2.13: Straight pipe geometry with a bulge in center. Analysis for this geometry is analogous
to the wall deformation in an artery with an aneurysm.
31
CHAPTER 3 Solution Methodology
In this chapter the discretization techniques of Navier-Stokes equation and continuity equation for
both clear and porous media are discussed. Further grid generation followed by quality
measurements and code validations are also presented. The Galerkin method for discretization of
solid mechanics equations is also described.
3.1. Discretization
The non-dimensional governing differential Equations (2.7), (2.8) and (2.9) are discretized using
the Finite Volume Method. The entire flow domain is divided into tiny tetrahedral elements. The
unstructured mesh is used to capture the flow patterns in each and every portion of this complex
flow domain. Semi-Implicit Method for Pressure Linked Equations (SIMPLE) algorithm is
implemented for the pressure velocity coupling. A detailed discussion on the discretization scheme
on unstructured mesh can be found in Date (2005). The cell centered collocated variable approach
is used to divide the whole domain. In order to append the impact of porous medium the Darcy
and Forchheimer terms have been added in the governing equation. Equations (2.7),(2.8) and (2.9)
in a combined form can be written as –
B qi
  M1 B  M 2 V B  S B (3.1)
t xi
1 B
where V  u1iˆ  u2 ˆj  u3kˆ and qi  ui B  eff
B
 xi
In Equation(3.1), both continuity and momentum equation are written in one generalized
form. Here the value of all the variables will depend upon the considered equation, such as – for
continuity equation B is one, whereas for momentum equation B indicates velocity ( ui ). The
description of other terms in the context of clear and porous medium is demonstrated in Table 3.1.
In the studies done by Date (2005), slight change from the Semi-Implicit Method for Pressure
Linked Equations (SIMPLE) algorithm are inducted such as pressure smoothing. Here onwards
the discretization methodology described in Date (2005) is used for both clear medium and porous
medium.
Table 3.1: Description of parameters used in generalized equation.
Equation B  eff
B
SB M1 M2
Continuity equation
(for both clear and 1 0 0 0 0
porous medium)
Momentum equation 1  p
ui  0 0
(clear medium) Re  xi
Momentum equation 1  p  
ui 
(porous medium) Re  xi Re Da Da
Collocated variable approach is advantageous while working on unstructured mesh, as it

can define scalar and vector entities at identical locations. Convective terms are discretized by a
hybrid upwind scheme that combines first and second order schemes. Geometry invariant features
of the tetrahedral element are used so that the calculation of gradients at cell faces is simplified
using nodal quantities of a particular variable. Nodal quantities in turn are calculated as a weighted
average of the surrounding cell-centered values. Diffusion terms are discretized using a second
order central-difference scheme.
Figure 3.1: A unit tetrahedral cell used in unstructured meshing of flow domains.
The discretized form of generalized governing differential equation is:
4
V 4
APu p   AEk uE ,k  S V  u 0p   Dk (3.2)
k 1 t k 1
34
The control volume considered is a tetrahedral (Figure 3.1) that’s why the value of index k
varies from one to four corresponding to each node of element.
Table 3.2: Description of parameters used in Equation (3.2).

Parameter Indicator/Value Parameter Indicator/Value
p Current control volume k Neighboring cell

cell
up Velocity component u 0p Velocity at previous time step
V 4
V Control volume AP   AEk  M1V  M 2 V p V
t k 1
1
AEk   dck  1  fck  Cck  Diffusion coefficient for kth face

d ck
Convection coefficient Source term based upon convection

Cck Dk
for kth face and diffusion coefficients
The final discretized form of pressure correction equation is:

4 4 4
AP p 'p   AEk pE' ,k   Cck   Dkp
'
(3.3)
k 1 k 1 k 1
Table 3.3: Description of parameters used in Equation (3.3).

Parameter Indicator/Value Parameter Indicator/Value
Pressure correction term in 4
p 'p
control volume
AP  AEk
k 1
 A2fk Under relaxation

AEk 
APckui factor for velocity
Coefficient of AP in
Af k k th cell face area APckui
Equation (3.2)
' Gradient of pressure
Cck Convection coefficient Dkp
correction term
The velocity field is calculated from Equation (3.2) using a guessed pressure gradient. The
correction value in pressure is calculated using Equation (3.3) and these steps are repeated until
the convergence criteria are satisfied.
35
3.2. Numerical Algorithm
The algorithm described in Date (2005) is used to solve continuity and momentum equations. The
steps to attain the solution are as follows:
(i) At a given time step guess a pressure field p .
(ii) Solve discretized momentum transport Equation (3.2) and get provisional velocity ( u * ) at
each cell.
(iii) Solve discretized pressure correction Equation (3.3) with the help of provisional velocity
( u * ) and get correction term in pressure ( p ' ) for each cell.
(iv) Calculate the smoothing pressure correction such that the predicted pressures do not exhibit
a zig-zag behavior.
(v) Get corrected pressure and velocity in each cell by following formulas ( l is iteration step):
plp1  plp  p'p (3.4)
V  p ' 
uil,p1  uil, p    (3.5)
APui  xi  p
(vi) Evaluate residuals from the imbalance equation for all velocity components according to:
1
  4  2
2
R     APu p   AEk uE ,k  Stotal   (3.6)
 all nodes  k 1  

Here, Stotal is the total source term, which is indicating the summation of all the R.H.S.
terms in Equation (3.2).
(vii) The mass residual is evaluated as:

1
  4  2
2
Rm     AP p   AEk pE ,k  
' '
(3.7)
 all nodes  k 1  

(viii) Check for convergence limits of R and Rm .
(ix) If convergence criteria are satisfied, then move to the next timestep and set the current
solution as the initial guess for next timestep.
(x) If convergence criteria is not satisfied, then set ul 1  ul , pl 1  pl and repeat from step (ii).
36
3.3. Numerical Solver
In the current study the discretized equations are solved for clear medium and porous medium in
three dimensional flow domain. The considered element shape is tetrahedral and its size is kept
quite small to attain the flow patterns in any type of complex geometry. The finite volume method
(FVM) code is written in C++ language and external open source hdf5 library is used to handle
adequately large mesh points. The computing power has been surged quite sharply in last few
decades using the parallel computing methods. Therefore the parallelization of code is performed
to get quicker results using openMP framework. Numerically the equations are solved using the
stabilized bi-conjugate gradient (BiCGStab) method.
3.3.1. Code parallelization

Parallel computing is accomplished by splitting up large and complex tasks across multiple
processors. In the parallel processing information is passed from one node to another within the
cluster, for that message passing operations MPI message passing library is used. In the current
code openMP method of parallelization is implemented. Shared memory systems can also vary
widely but they all have the ability for each processor to access all memory as a global address
space. The configuration of openMP for a shared memory system where each of the processors is
directly connected to the global memory, it allows multiple processors to operate independently
while still having access to all the same memory resources. The advantages of using a shared
memory parallelization is that it is relatively simple to make existing serial codes parallel. There
are a few disadvantages which include the possibility that multiple cores and processors accessing
the shared memory simultaneously could cause a bottleneck which will slow down a program.
Also, adding more processors does not increase the amount of memory available which could be
a problem. Finally, the programmer is responsible for making sure that writing to the global
memory is handled correctly. This is particularly important when a variable is being read and also
written in calculations.
In this study the FVM code written in C++ is parallelized using the openMP directives.
The fork-join method is implemented for this parallelization where openMP operates on a Fork
and Join model of parallel execution. All openMP programs begin as a single process which is
called the master thread. This master thread executes sequentially until a parallel region is
encountered. At this point the master thread ‘forks’ into a number of parallel worker threads. The
instructions in the parallel region are then executed by this team of worker threads. At the end of
37
the parallel region, the threads synchronize and join to become the single master thread again. The
single construct allows code that is serial in nature to be executed inside a parallel region. The
thread executing the code will be the first to reach the directive in the code. It doesn't have to be
the master thread. All other threads proceed to the end of the structured block where there is an
implicit synchronization.
3.4. Flow Parameters

The blood flow is considered incompressible laminar and non-Newtonian. Various flow
parameters used in this study, are listed in Table 3.4.
Table 3.4: Description of flow parameters.

Parameter Value Parameter Value
Time averaged
 1050 kg/m3 Reynolds 500
number
Porosity (  ) = 0.735
Carreau  0  0.16 Pa  s
 Porous Permeability( K ) = 1.55 108
Yashuda    0.00392 Pa  s
m  8.2, n  0.64, a  1.23 medium m2
model
 Inertia coefficient ( C f ) = 0.2
 3.14; Rest condition K

Womersley
Wo  R  Darcy number Da   7.65 104
number  4.35; Exercise condition d 2
Based upon this data the maximum and minimum viscosity are 0.16 and 0.00392 Pa.s. It confers
that the maximum and minimum Reynolds number will be 500 and 14.
38
3.5. Grid Generation
The efficiency of code is highly dependent on mesh quality and element size, therefore a high
quality mesh is generated through ICEM CFD software. The unstructured tetrahedron mesh is
generated to obtain the flow parameter. In order to get precise results at the boundary locations,
finer mesh is generated near the surfaces of geometries. A detailed report (Table 3.5) on the mesh
quality, elements and nodes, is presented below:
Table 3.5: Details of meshing parameters for the geometries considered in this analysis.
Patient specific healthy artery Patient specific artery with an Artery geometry after coil
geometry aneurysm embolization
Number of Number of Number of

961239 1029827 1071132
elements elements elements
Number of nodes 164735 Number of nodes 175242 Number of nodes 183436
Mesh quality Elements within Mesh quality Elements within Mesh quality Elements within
range range (%) range range (%) range range (%)
0.9 – 1.0 75.84 0.9 – 1.0 74.97 0.9 – 1.0 75.47
0.8 – 0.9 12.93 0.8 – 0.9 13.68 0.8 – 0.9 12.02
0.7 – 0.8 8.26 0.7 – 0.8 8.65 0.7 – 0.8 9.14
39
Figure 3.2 shows a closer view of meshing of patient specific cerebral aneurysm model.
The number of elements in the aforementioned geometry are around one million and more than
85% of elements have mesh quality more than 80%. Finer mesh is generated near the walls to
capture the flow field precisely.
Figure 3.2: Tetrahedral meshes at the inlet plane, the aneurysm cross-section and the outer surface
near the aneurysm. Mesh is progressively refined to the walls while maintaining its quality.
40
3.6. Validation of FVM Code
In this section, the validation of FVM code written in C++ is reported for steady as well as unsteady
cases. The validation of the results obtained through this code is accomplished against the work of
Timité et al. (2010). Here, a tube with a right-angled bend is considered. Steady flow and unsteady
flow simulations are compared. Secondary flow contours and plots are shown at the exit of the
bend.
3.6.1. Steady flow in a 90o bend tube

The flow is considered to be uniform and steady at the inlet of the tube. The diameter of the tube
is 4 mm. The 90o bend has 24 mm radius of curvature. At the start of the bend a tube section of
250 mm is added to ensure that the flow gets fully developed before entering into the bend region,
similarly another tube section of 50 mm is joined at the end of the bend. An unstructured tetrahedral
meshing is performed on the tube and over one million elements are generated.
Figure 3.3: Geometry of a circular tube with a 90o bend considered for validation. Inlet length to
diameter ratio is 62.5 and the exit length to diameter ratio is 12.5.
At the exit of bend the secondary flow contours are plotted and they are compared with the
results of Timité et al. (2010). The reference figures are obtained through experiments using laser
induced fluorescence flow visualization technique. In Figure 3.4, the comparison between the
results acquired through simulations and the reference are shown.
41
Figure 3.4: Validation of finite volume simulator of fluid flowing in a tube with a right-angled
bend. Secondary flow in the bend is shown at three Reynolds numbers (300, 600 and 1200). First
row is experimental data recorded by a laser induced fluorescence technique (Timité et al. (2010)),
second row is obtained from the numerical simulation. Overall flow field is steady.
3.6.2. Pulsatile unsteady flow in a 90o bend tube

The geometry considered, is a tube with 90o bend (Figure 3.3) as discussed in Section 3.6.1. A
time varying spatially uniform velocity boundary condition is enforced at the inlet of the tube and
the pressure is kept constant (zero) at the outlet.
U  0.15  0.15sin(2t ) (3.8)
where  is 5.866 Hz.
A slice is extracted at the exit of the bend. Both x and y axis are in radial outward direction
as shown in Figure 3.5. x axis is in the plane where centripetal force will have its impact whereas
the y direction is perpendicular to that plane.
42
Figure 3.5: Cross-sectional view of the tube at the exit of the bend
U  U st  U osc sin(2t ) (3.9)

To flow parameters are devised here to provide information of the flow properties. The
ratio of stationary velocity to the oscillatory velocity amplitude is  and the other parameter is
Womersley number ( Wo ) which deals with the pulsation of the flow.
U st 0.15
  1 (3.10)
U osc 0.15
2 36.86
Wo  R  0.002  12.14 (3.11)
 106
Figure 3.6 represents a comparison of the velocity profiles between the reference plots
(Timité et al. (2010)) and the plots acquired from the simulation results at various timesteps for
pulsatile flow (3.8). In a single plot, three distinct curves are plotted for selective time phases. Plot
with highest values of velocity represents the timestep corresponding to t  90o , similarly rest
of the two curves belong to t  180o and t  270o . For each time phase the results obtained via
FVM simulations are compared with the experimental results and the numerical results presented
in Timité et al. (2010).The effect of centrifugal force can be seen in the plot of x direction
velocities.
43
Figure 3.6: Validation of the numerical simulator against experiments for pulsatile flow in a tube
with a bend. Selected phases of oscillation are considered. Re = 600, Wo =12.14. Coordinates x
and y are defined in the cross-sectional plane of the tube.
In the x direction, due to the centripetal force the flow tends to flow at a higher rate (higher
velocity) near the outside wall of the bend that can be verified through the data. In the y direction,
due to the geometrical and flow symmetry the velocity profiles are symmetric about the centerline
as shown in Figure 3.6.
3.6.3. Developing flow in a straight tube

The FVM code is validated for a uniform and steady flow of a Newtonian fluid at the inlet of the
tube. The tube diameter is 4mm and fluid velocity at inlet is 0.075 m/s. After some certain entrance
length the flow will become fully developed and it will have a parabolic velocity profile with peak
velocity at the axis and zero velocity at the tube walls. At an axial position 200 mm (50d) away
from the inlet the velocity profile is plotted in Figure 3.7 and compared with the analytical solution
of a parabola.
44
Figure 3.7: Non-dimensional velocity variation with non-dimensional radial position.
Calculation of Darcy friction factor: One more parameter (friction factor) is also calculated to
verify the results of FVM code. As the flow belongs to the laminar region, the analytical value of
Darcy friction factor will be:
64
f  (3.12)
Re
ud 1000  0.0075  0.004
Re  
 0.001
Re  300 (3.13)
Putting Equation (3.13) in Equation(3.12), we will get
f  0.2133 (3.14)
Now, the calculation of friction factor is performed, using simulation shown in Figure 3.8.
In the figure the pressure is plotted in the fully developed region.
px0  29.8639 Pa
px0.2  0.0525Pa
p L U2
 f (3.15)
 d 2
45
Substituting the parameters in Equation(3.15), we will get
f  0.212 (3.16)
f  Re  0.212  300  63.6 (simulation)
Figure 3.8: Pressure variation along axial direction.
46
3.7. Solution Methodology for Biomechanics
As discussed in Section 2.5, the artery walls comprises three distinct materials tunica intima, tunica
media and tunica adventitia. The three layers possess different moduli of elasticity. For the present
analysis it is assumed that the composite material can be replaced by a single material with an
equivalent elastic modulus. The verification of this assumption is presented in a later chapter.
3.7.1. Calculation of equivalent elastic modulus

The data correspond to each layer is reported in Table 3.6. Based upon this data the calculation of
equivalent elastic modulus is carried out. The data is taken from Khamdaeng et al. (2012).
Table 3.6: Data table for three different materials of arterial walls.
Material Thickness (in mm) Elastic modulus (in MPa)
Tunica intima 0.04 0.8
Tunica media 0.32 0.9
Tunica adventitia 0.12 0.19
In each layer the stress will be the same. However the strain and change in thickness will
be different so,
  Eeq eq
t1  t2  t3
 eq 
ttotal
  
t1  t1 t2  t2 t3  t3
E1 E2 E3
On solving these equations
 t1   t2   t3 
     
  total    ttotal    ttotal 
1 t
Eeq E1 E2 E3
Eeq  0.462 MPa
47
3.7.2. Governing differential equations
For the analysis of wall deformation, the solid mechanics equations need to be solved. In the
present study, the domain is considered in Cartesian coordinates. The appropriate governing
differential equations are reported below.
Figure 3.9: Schematic depiction of normal and shear stresses in Cartesian coordinates
Balancing the force in x direction
  x    xy 
  x dydz  x dxdydz    x dydz   xy dxdz  y dxdydz    xy dxdz 
   
y  z plane x  z plane
  xz 
 xz dxdy  z dxdydz    xz dxdy  Xdxdydz  0
 
x  y plane
After rearranging, the resultant equation in the x direction will be

 x  xy  xz
  X 0
x y z
Similarly, balancing the force in y and z directions, the following GDE’s will be obtained:
 xy  y  yz
  Y  0
x y z
48
 xz  yz  z
  Z 0
x y z
To determine the relationship between stress and strain, constitutive equations are used as
follows:
x  1  v  0 0 0  x 
    
 y    1   0 0 0    y 
  E    1  0 0 0  z 
 z    
 yz  (1  )(1  2 )  0 0 0 1 2
2
0 0    yz 
   0 1 2 0    xz 
  xz  
0 0 0 2  
 xy  1 2  
   0 0 0 0 0  
2   xy 
[ D]
where strain matrix is correlated to deformation (displacement) matrix as:
  x   x 0 0 
    
 y   0 y 0 
   0   u 
0 z  
 z  
1  v
  yz   0 1 
2 z 2 y   
  1  1  
 w
  xz   2 z 0 2 x 
  xy   12 y 1 
0 
   2 x
3.7.3. Discretization
To discretize the governing differential equations, Galerkin method of weighted residual approach
is used. The 2D cross-section of the tube is shown in Figure 3.10. The whole domain is divided in
triangular shape elements (Figure 3.11).
fixed fixed
R
wall pressure wall shear stress
(traction in y direction) (traction in x direction)
Figure 3.10: Two dimensional cross-section of a pipe. Wall pressure and wall shear stress are
exerted at the inner surface of the tube. Wall pressure is along the radially outward direction and
wall shear stress is in the axial direction.
49
Figure 3.11: Demonstration of triangular meshing of the considered domain. Lower plot
showcases zoomed in view of the meshes.
In the present study, body forces are not present. At the two extreme boundaries, fixed
displacement boundary condition is imposed. On the inner side of the pipe where it is in direct
contact with blood, traction boundary conditions are applied. Traction has two components in x
and y directions. Wall pressure causes traction in the y direction (radially outward) and wall shear
stress in x the direction (axial direction).
All surface boundaries can have two type of boundary conditions:
(i) Displacement boundary condition or fixed boundary condition ( u  0, v  0, w  0 )( u )
(ii) Traction boundary condition (  q )
t  t xiˆ  t y ˆj  t z kˆ
n  nxiˆ  ny ˆj  nz kˆ
50
 x  xy  xz   n  t 
  x  x
 xy  y  yz  n y   t y 
    
 xz  yz  z   nz  t z 
So, the traction boundary in the x direction will be
 x nx   xy ny   xz nz  t x
Discretization is performed considering a 2D model and taking two weighted residual functions to
make the collective integral zero:
  x  xy 
 Wi,1  x

y

 tdxdy   Wi ,1  x nx   xy n y  t x tds  0 
  q
 Wi ,1 W 
 Wi,1  x nx ds   xy ny ds  t    x
 
 x  i ,1  xy  tdxdy   Wi ,1  x nx   xy ny  t x tds  0
y 
   q
Put Wi ,1  Wi ,1 on  q and Wi ,1  0 on u
 Wi ,1 W 
 x
 x  i ,1  xy  tdxdy   Wi ,1t xtds
y 
  q
Similarly, in the y direction

 Wi ,2 W 
  x
 xy  i,2  y  tdxdy   Wi ,2t ytds
y 
  q
These equations can be written in matrix form as:
 Wi ,1 Wi ,1 
 
 x 0
y   
x
Wi ,1 0  t x 
  Wi ,2
 y  tdxdy   
Wi ,2   
  tds
0 Wi ,2  t y 
 q 
 0  
 y x   xy 
The considered domain is thin walled, thus plane stress model of stress-strain relationship is used
to correlate stresses with strains.
  1  0  x   0
 x    x  u
E     
 y    1 0    y    D  0 y   
  1 
2
0 0 1      v 

 xy   2   xy   y

x 

[ D] [ L]
51
The whole domain is divided in triangular elements with three nodes ( Ni , N j , Nk ) per element:
N i  ai  bi x  ci y N j  a j  bj x  c j y N k  ak  bk x  ck y
x j yk  xk y j xk yi  xi yk xi y j  x j yi
ai  aj  ak 
2A 2A 2A
y j  yk y  yi yi  y j
bi  bj  k bk 
2A 2A 2A
xk  x j x x x j  xi
ci  cj  i k ck 
2A 2A 2A
where A is area of triangular element.

u( x, y)  Ni ( x, y)ui  N j ( x, y)u j  Nk ( x, y)uk
v( x, y)  Ni ( x, y) vi  N j ( x, y) v j  Nk ( x, y) v k
 ui 
v 
 i
u   Ni 0 N j 0 N k 0  u j 
   
 v  0 Ni 0 N j 0 N k   v j 
u 
 k
 vk 
Substituting these equations in the matrix integral equation and simplifying the resultant equation
in matrix form can be written as:
 ui    Fix  
 v    Fiy  

kij 
 kii   ik   i     
k 
 u 
 j   F jx 
  k jj   
 k
 ji
k jk      
  v j   F jy 
k 
 ki kkj   kk  uk   F 
k
   kx 
 vk    Fky  
 
kij     L Ni   D L  N j  tdxdy

T
where
The force matrix can be written in the following form:
52
  tx sij  
 2 
 
  Fix     ty sij  
    2 
  Fiy    
 F   tx s jk 
 
 jx    2  t
    
 F jy   ty s jk 
   2 
  Fkx     t s 
  Fky     x ki 2  
  
 
  ty ski  
  2  
where t represents average traction on the elemental edge.

In order to calculate the deformation at each node, node-wise stiffness matrices are calculated.
These elemental matrix are assembled together to form a global stiffness matrix.
  
k global  uglobal  Fglobal 
Depending upon the boundary conditions, known displacement nodes are separated from the
unknown nodes. For example the boundaries which are fixed, nodes have zero displacements.
These nodes are the ones for which the values of force matrix are unknown and the traction at the
fixed boundary is not known at the initial stage. For the remaining boundaries where the traction
boundary conditions are imposed, these nodes are classified as unknown displacement nodes. For
them displacement is yet to be calculated.
The global stiffness matrix is divided in two parts. One corresponding to the nodes for
which displacement is known and the other one belonging to the unknown displacement nodes.
Hence
kkn ukn   kun uun   Fun 

 kkn  matrix is extracted from the global stiffness matrix. It comprises the elements corresponding
to rows of unknown displacement and columns of known displacement nodes and  kun  matrix
will include the elements of global stiffness matrix corresponding to rows of unknown
displacement and columns of unknown displacement nodes. Similarly Fun  also belongs to the
nodes which have unknown displacement. For these nodes the force matrix will be known. Now
using simple matrix operations, the unknown displacements can be calculated readily.
53
uun   kun 1 Fun   kun 1  kkn   ukn 
3.7.4. 3D Discretization
3D discretization of governing differential equations, is performed using Galerkin method of
weighted residual approach considering a trapezium prism element.
Each surface boundary may have one out of two types of boundary conditions, listed below:
(i) Displacement boundary condition or fixed boundary condition ( u  0, v  0, w  0 )( u )
(ii) Traction boundary condition (  q )
t  t xiˆ  t y ˆj  t z kˆ
n  nxiˆ  ny ˆj  nz kˆ
 x  xy  xz   n  t 
  x  x

 xy  y  yz   n y   t y 
    
 xz  yz  z   nz  t z 
So, the traction boundary in the x direction will be
 x nx   xy ny   xz nz  t x
Discretization is accomplished considering two weighted residual functions to make the collective
integral zero
   x   xy   xz 
  x  y  z
Wi ,1  
 dxdydz   Wi ,1  x nx   xy n y   xz nz  t x dydz  0
  q
 Wi ,1 Wi ,1 Wi ,1 

 Wi ,1 
 x n x   xy n y   xzn z dsdz    x
  x 
y
 xy 
z
 xz  dxdydz 
  
 Wi,1  x nx   xy ny   xz nz  tx  dsdz  0
q
Put Wi ,1  Wi ,1 on  q and Wi ,1  0 on u
 Wi ,1 W W 
  x
 x  i ,1  xy  i ,1  xz  dxdydz   Wi ,1t x dsdz
y z 
  q
Similarly, solving the y and z component equations
54
 Wi ,2 W W 
  x
 xy  i ,2  y  i,2  yz  dxdydz   Wi ,2t y dsdz
y z 
  q
 Wi ,2 W W 
  x
 xz  i ,2  yz  i,2  z  dxdydz   Wi ,2t z dsdz
y z 
  q
These equations can be written in matrix form as:
 Wi ,1 Wi ,1 Wi ,1   x 

  
z   y 
0 0 0
 x z
Wi ,1 0 0 
 Wi ,2 Wi ,2 Wi ,2   z   
 0 y
0
z
0    dxdydz    0 Wi ,2
x   yz 
0 dsdz
 q  0 0 Wi ,3 
 Wi ,3 Wi ,3 Wi ,3    
 0 0 0   xz 
 z y x   xy 
Constitutive equations to relate stress and strain can be written in matrix form as:
x  1  v  0 0 0  x 
    
 y    1   0 0 0    y 
  E    1  0 0 0  z 
 z    
 yz  (1  )(1  2 )  0 0 0 1 2
2
0 0    yz 
   1 2 0    xz 
  xz  
0 0 0 0 2  
 xy  1 2  
   0 0 0 0 0  
2   xy 
[ D]
Strains can be related with directional displacements as:


  x   x 0 0
    
 y  
0 y
0
   0   u 
z   
0
 z    v 
  yz   0

z y  
     w
  xz   z

x 
0
  xy    
0 
   y x 
[L]
The whole domain is divided in trapezoidal elements with eight nodes per element and their
corresponding shape functions are listed below:
55
1 1
Ni   xc  x  a  yc  y  b  zc  z  c  Nm   xc  x  a  yc  y  b   zc  z  c 
8abc 8abc
1 1
Nj    xc  x  a  yc  y  b  zc  z  c  Nn    xc  x  a  yc  y  b   zc  z  c 
8abc 8abc
1 1
Nk    xc  x  a   yc  y  b  zc  z  c  No    xc  x  a   yc  y  b   zc  z  c 
8abc 8abc
1 1
Nl   xc  x  a   yc  y  b  zc  z  c  Np   xc  x  a   yc  y  b   zc  z  c 
8abc 8abc
where a b and c are sides of the element.

8 8 8
u ( x, y)   Ni ( x, y ) ui , v( x, y)   Ni ( x, y) vi , w( x, y)   Ni ( x, y) w i
i 1 i 1 i 1
   ui 
 u   Ni 0 0 Nj 0 0 Np 0 0   vi 
     
v    0 Ni 0 0 Nj 0 ..... 0 Np 0   wi 
 w  0  
   0 Ni 0 0 Nj 0 0 Np . 
 [ Ni ]   . 
Substituting these equations in matrix integral equation and after simplification the
resultant equation in matrix form, can be written as:
 Fix 
 kii 

. . kip    ui   
 vi   Fiy 
 . . . .    
   wi    Fiz 
 . . . .  .   . 
 
 k
 pi . . k pp     
  .   . 
kij     L Ni   D L  N j  dxdydz

T
where
Rest of the solution procedure to calculate the deformation is as described in Section 3.7.3.
3.7.5. Effect of multilayers of the artery wall

As discussed earlier the artery walls consist of three distinct layers of materials, which are tunica
intima, tunica media and tunica adventitia (Figure 2.10). In the previous section the discretization
procedure assuming these three layers to be replaced by an equivalent material was presented. In
this section the solution methodology to capture the effect of multilayered materials is described.
56
Every element has its own stiffness matrix. In the formation of global matrix these
elemental stiffness matrix are appended in a certain manner depending upon the connectivity (node
numbers) of the elements. In the global matrix, the element corresponding to ith node (Figure 3.12)
will have the contribution from its connected elements which are b, c, d, e, f and g.
Figure 3.12: Triangular meshing of two distinct materials. Node i is shared by material 1 and
material 2.
Regions 1 and material 2 are two different materials having distinct moduli of elasticity. In
the previous section where single material is considered, only single D (3.17) matrix is considered
for every element. Here D matrix will be dependent upon the material in which the element resides,
i.e.
1  v  0 0 0 
 
  1   0 0 0 
E    1  0 0 0 
[ D]    (3.17)
(1  )(1  2 )  0 0 0 1 2
2
0 0 
 0 0 0 0 1 2 0 
 2
1 2

 0 0 0 0 0 2  
The D matrix will depend upon the elasticity of material.
In the code an extra loop is incorporated to determine where the considered element resides
and with respect to that the D matrix is fed to calculate elemental stiffness matrix. Rest of the
procedure to calculate the global stiffness matrix remains unchanged. Futher
57
kij  kik  
 kii 

  k jj  k jk 
[kele ]   k ji

k 
 ki kkj  kkk 
 
where kij    L Ni   D L  N j  t dxdy .
T
58
CHAPTER 4 Flow Patterns in a Healthy Patient Specific Geometry
In this chapter, the results obtained by FVM code are presented. The results start with a medically
stable condition which is, blood flow in a healthy artery geometry for a person at rest under normal
blood pressure condition. In further cases, the study is carried out on patient specific cerebral
aneurysm geometry followed by a patient treated with coil embolization with rest and exercise
condition under high and normal blood pressure.
The order of cases presented in this and subsequent chapters, is shown in Table 4.1:
Table 4.1: Sequence of cases presented in the next few chapters.

Geometry Inlet BC Outlet BC
Healthy Rest Condition Normal Blood Pressure
Healthy Rest Condition High Blood Pressure
Healthy Exercise Condition Normal Blood Pressure
Healthy Exercise Condition High Blood Pressure
Geometry with Aneurysm Rest Condition Normal Blood Pressure

Geometry with Aneurysm Rest Condition High Blood Pressure
Geometry with Aneurysm Exercise Condition Normal Blood Pressure
Geometry with Aneurysm Exercise Condition High Blood Pressure
Geometry with Porous Aneurysm Bulge Rest Condition Normal Blood Pressure
Geometry with Porous Aneurysm Bulge Rest Condition High Blood Pressure
Geometry with Porous Aneurysm Bulge Exercise Condition Normal Blood Pressure
Geometry with Porous Aneurysm Bulge Exercise Condition High Blood Pressure
The parameters plotted in the diagram are in non-dimensional form where non-dimensional
parameters are acquired by dividing the dimensional parameters with appropriate dividing scale as
defined in Table 2.1.
4.1. Results and Discussion
Flow patterns in a healthy artery geometry are presented here. The cross-sectional plane of
aneurysm on which the flow velocity contours are drawn is shown below:
Figure 4.1: Three dimensional cross-section plane on which the velocity contours are plotted.
Time-averaged and mean removed root mean square (RMS) quantities are reported. For
each case the FVM code is run for ten cycles of oscillation. In the time-averaged and RMS plots,
the last two cycles are considered for averaging. Time-averaged data is obtained for velocity, wall
pressure and wall shear stress. This data is subtracted from the instantaneous data for the RMS
calculation.
Blood flow is considered incompressible, unsteady and non-Newtonian. In order to capture
the effect of shear thinning behavior of non-Newtonian flow, Carreau-Yashuda model is
incorporated. At the boundary of a clear medium and a porous medium, the continuity of velocity
patterns and other parameters was obtained.
Figure 4.2 demonstrates the time-averaged and mean removed RMS plots of velocity
contours, wall pressure and wall shear stress. The situation presented is for a healthy person at rest
under normal blood pressure. In the contours, it can be seen that there are significant values of
60
velocity field and wall shear stress near the bend region. In Figure 4.3, a comparative analysis is
shown through plots between phases ‘a’ and ‘b’. Phase ‘a’ corresponds to the time instant at which
the velocity is at its peak at inlet and phase ‘b’ indicates the instant of minimum velocity that
follows phase ‘a’. Similarly in Figure 4.5, the phases ‘a’ and ‘b’ belong to the time instants for rest
condition under high blood pressure. Figure 4.4 is plotted for time-averaged and mean removed
RMS data for a person at rest under high blood pressure condition. It can be seen with the help of
the plots that the velocity magnitudes in the flow domain have increased slightly whereas a lot
more increment in pressure levels, is observed in the case of high blood pressure compared to
normal blood pressure. There has been marginal changes in the values of wall shear stress also.
From the plots of wall shear stress and wall pressure, it can be said that near the bend of the artery
wall shear stress is abnormally high. According to the literature, it is observed that sudden change
in wall shear stress may cause the formation of aneurysms.
In Figure 4.6 and Figure 4.8 the time-averaged and RMS velocity magnitudes, wall
pressure and wall shear stress trends are reported for normal blood pressure and high blood
pressure under exercise conditions. As the peak velocity is higher in the case of exercise condition,
the velocity levels are significantly elevated in the flow region compared to the person at rest.
Moreover, in the scenario of high blood pressure the velocity magnitudes are higher compared to
normal blood pressure for these exercise conditions. The pressure values for high blood pressure
are quite high and showcase same behavior as in rest conditions. As discussed in previous
paragraph, a sudden turn in flow direction results in higher level of local velocity magnitudes, wall
shear stress and wall pressure at the outer wall of the healthy artery near the bend. This behavior
can cause a local enlargement of the artery near the bend, namely an aneurysm. In Figure 4.7 and
Figure 4.9, comparisons are carried out between phases ‘a’ and ‘b’ for velocity, pressure and wall
shear stress. Not only in time-averaged and mean removed RMS plots but also at phases ‘a’ and
‘b’ similar trends are seen with different magnitudes though. At phase ‘a’ the velocity magnitudes
have escalated compared to phase ‘b’. Similarly wall pressure and wall shear stress also higher for
peak velocity phase compared to the minimum velocity phase. The time-averaged values of the
flow properties for rest and exercise condition under a given blood pressure appear to have similar
magnitudes. The RMS values differ quite considerably. In the cases of high blood pressure there
has been a significant variation in pressure values and velocity patterns compared to normal blood
pressure for both rest and exercise conditions.
61
Let us compare two extreme cases when a patient is at rest with normal blood pressure and
a patient performing exercise under high blood pressure. The flow parameters such as it velocity
near the bend, wall pressure and wall shear stress, have quite high values. Near the turn at the outer
side of wall, the values of wall shear stress and wall pressure are significantly elevated in the case
of exercise condition under high blood pressure compared to rest under normal blood pressure.
Analyzing the impact of high blood pressure and normal blood pressure for the same physical
condition, we can infer that high blood pressure has adverse impact on the health of patient and it
is more likely condition for the occurrence of aneurysm. Similarly from the analysis of rest and
exercise condition with a given intracranial pressure, it can be concluded that exercise condition
enhances the risk of aneurysm formation compared to the rest condition.
In the exercise conditions the frequency of pulsation is two times higher than that of rest
conditions as the time period of oscillations for exercise condition is 0.45 seconds compared to
0.86 seconds for rest. Thus for a given period of time more pulsation cycles will occur in exercise
condition. The corresponding fatigue stresses will also be higher for exercise conditions. In
addition the pulsation of wall shear stress will be heightened due to lower time period. The
literature shows these to have harmful effects on the arteries.
This analysis on a healthy patient specific geometry concludes that the probable location
of aneurysm initiation is in the zone at the outer wall of the artery near the bend. The exercise
condition enhances the forces in the concerned zone due to flow impingement of the blood. High
blood pressure creates even worse conditions.
Table 4.2: Peak variation of flow parameters at the outer wall near the bend.
Time averaged RMS
Maximum Maximum Maximum Maximum Maximum Maximum
velocity pressure WSS velocity pressure WSS
normal
1.12 79.54 13.3 0.36 12.8 5.7
BP, rest
high BP,
1.32 107.6 15.6 0.54 17.8 6.9
rest
normal
BP, 1.36 79.86 16.1 0.58 13.4 7.2
exercise
high BP,
1.54 108.9 18.4 0.73 19.5 11.4
exercise
62
under rest conditions.
63
pressure and wall shear stress in a healthy artery for normal blood pressure at rest conditions. Phase
minimum velocity that follows phase ‘a’.
64
under rest conditions.
65
pressure and wall shear stress in a healthy artery for high blood pressure at rest conditions. Phase
minimum velocity that follows phase ‘a’.
66
under exercise conditions.
67
pressure and wall shear stress in a healthy artery for normal blood pressure under exercise
corresponding to minimum velocity that follows phase ‘a’.
68
under exercise conditions.
69
pressure and wall shear stress in a healthy artery for high blood pressure under exercise conditions.
Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an instant corresponding
to minimum velocity that follows phase ‘a’.
70
CHAPTER 5 Flow Patterns in a Patient with an Aneurysm
In the present chapter, simulation data of pulsatile flow in a patient specific geometry with an
aneurysm are presented.
5.1. Vortex Formation inside the Aneurysm Bulge

In the patient specific cerebral aneurysm model a recirculation pattern is observed as shown in
Figure 5.1. The strength of this vortex is dependent upon the boundary conditions which are
imposed at inlet and outlet planes.
Figure 5.1: Three dimensional stream traces of the time averaged flow field formed in a patient
specific artery in the presence of an aneurysm. Two views of streamtraces clearly reveal vortex
formation in the bulge of the artery.
Studies suggest that the recirculation patterns further weakens the aneurysm wallsBoussel
et al. (2008). Therefore the vortex formation inside the bulge is considered to have a negative
impact on the health of the patient. When the aneurysms are treated with coil embolization or by
other methods, doctors try to minimize the strength of vortex in the aneurysm sac. Hence a
comparison of vortex strength before and after coil insertion is discussed in chapter 6. In small
sized aneurysms the vortex plays major role as it advances the wall shear stress on the aneurysm
walls. Blood has a tendency to clot if it is stationary or moving at a low speed which further leads
into bio-chemical reactions. Vortex formation does not let the blood to clot due to its swirling
nature. Thus, vortex formation in the bulge has a favorable influence.
One more physical parameter known as residence time, is also related to the vortex
formation in the bulge. Calculation of residence time is discussed later in this chapter.

Results obtained in an unhealthy artery geometry with an aneurysm is further discussed here. The
study is carried out from the rest condition under normal blood pressure condition to the exercise
condition under high blood pressure. The comparison of time-averaged flow in Figure 5.4 and
Figure 5.6 showcases that the high blood pressure condition increases the values of flow velocity
inside the aneurysm bulge compared to normal blood pressure for given physiological condition
at the inflow plane. With the help of Figure 5.4, Figure 5.6, Figure 5.8 and Figure 5.10, it can be
observed that an exercise condition increases the strength of vortex in the bulge in comparison to
rest condition for the same intracranial pressure. Figure 5.5 shows that at phase ‘a’ the pressure
values, wall shear stress and flow patterns are dominant compared to phase ‘b’. Phases ‘a’ and ‘b’
have the usual meaning as discussed in previous chapter. The time-averaged data of velocity
magnitudes and wall shear stress for same physiological condition looks the same but the
fluctuations in the case of exercise condition or high blood pressure condition are pretty
distinguishable.
Compare two extreme conditions, when a patient is at rest with normal blood pressure
against exercise condition under high blood pressure. Then for the case exercise condition under
high blood pressure flow patterns, wall pressure and wall shear stress are way ahead than rest
condition with normal blood pressure. The instantaneous flow patterns further clear the picture. In
the exercise condition with high blood pressure case at phase ‘a’, the sharp rise in wall pressure,
velocity field and wall pressure can be seen compared to phase ‘b’. The fatigue stress depends
upon the fluctuation amplitudes and the frequency of pulsation cycles. Frequency of oscillation for
exercise condition is nearly twice of rest condition. In addition, the fluctuation amplitudes shown
in Figure 5.9 and Figure 5.11 for exercise condition are higher than that for a patient at rest (Figure
5.5 and Figure 5.7). It infers that in this case the walls will experience greater fatigue stress due to
the high amplitude of pulsating forces and frequency of oscillation. These stresses will lead to
rupture of aneurysm walls.
72
It can be explained through the observations that the flow is impinging on the weak surface
of the aneurysm due to a turn in flow geometry. As discussed earlier that this impingement or
striking of the fluid on the outer surface of the bend becomes the major reason behind the initiation
and growth of an aneurysm at the bend location. This impingement now gives the rise to the vortex
formation in the bulge.
In terms of the values obtained in cerebral aneurysm geometry, it can be reported that wall
pressure for exercise condition under high blood pressure are 1.5 times higher than rest condition
with normal blood pressure. The averaged flow velocity in the aneurysm bulge for high blood
pressure is two times that of for normal blood pressure. The time-averaged values for the same
physiological condition at the inlet, are of the same order but at some preferred instances the
parameters are quite different. The fluctuations in flow parameters obtained via mean removed
RMS curves are distinguishable for all the scenarios. The exercise condition increases the strength
of vortex in the aneurysm bulge. Higher values of wall shear stress and velocity magnitudes for
exercise condition will not let the blood to clot. It will further support in removal of deposited
plaque on the arteries which might be beneficial to combat Atherosclerosis.
5.3. Relative Particle Residence Time

Particle residence time indicates the average time for which the blood particles reside in the
aneurysm bulge. Whenever the blood has stagnation or very low velocity, it tends to convert itself
into gel and deposit as a solid coating. This phenomenon in known as blood clotting or coagulation.
If the blood clots inside the aneurysm, then bio-chemical reactions will take place and the
aneurysm walls will be eroded over a period of time. Studies carried out so far, explain that particle
residence time has a strong correlation with blood clotting Soulis et al. (2011). If the particle
residence time in the aneurysm dome is high enough then the tendency of the blood to clot will
also be higher.
5.3.1. Quantification of relative particle residence time
Although the exact calculation of particle residence time, has its own intricacies involved in it. An
approximate analysis can be found in literature. According to Soulis et al. (2011) and Xiang et al.
(2011) particle residence time is defined mathematically as follows:
1
PRT (5.1)
1  2OSI WSS
73
 T 

1
 WSS dt 

where OSI  1  T0
 and WSS is wall shear stress.
2
WSS dt 
  
 0 
Figure 5.2 shows the stream traces for a patient at rest with normal blood pressure and
exercise condition under high blood pressure. In both the three dimensional plots the particles were
released from the same spatial location at inlet. The left figure depicts that the particle has greater
circulation in the bulge than the particle in right figure. These higher circulatory motion will result
into higher particle residence time.
The particle residence time contours are plotted in Figure 5.3 for two extreme events when
patient is at rest with normal blood pressure and exercise condition under high blood pressure.
These plots exhibit that the blood particle will spend lesser time in an aneurysm bulge in the cases
of exercise condition under high blood pressure compared to rest condition under normal blood
pressure. Therefore the probability of blood clotting will be lesser under exercise conditions.
The time period of oscillation in case of exercise condition is smaller than that of rest
condition. In addition to that in the earlier sections it has been described that exercise condition
exhibits higher velocity magnitudes in the aneurysm bulge. Therefore it can be said that as far as
blood clotting is considered the exercise condition provides an adverse environment for the blood
to clot.
For high blood pressure condition compared to normal blood pressure condition
irrespective of physical condition, the velocity magnitudes are elevated in the aneurysm bulge.
Though the high blood pressure condition exerts higher forces on the walls, it reduces the particle
residence time as well. One can infer that the blood clotting is difficult under high blood pressure
with exercise condition compared to normal blood pressure at rest condition.
Particle residence time also has an impact on the deposition of plaque that leads to
atherosclerosis. Due to the higher residence time, the blood converts itself into a gel like substance
which makes other substances to stick to it and finally they deposit on the walls. During exercise
conditions the particle residence time will reduce and tendency of blood clotting and plaque
deposition will decrease. Physicians recommend to exercise regularly to a patient with an
aneurysm. The relative reduction in particle residence time and the clotting behavior of blood are
the probable reasons behind their recommendations.
74
Figure 5.2: Particle motion in patient specific artery with aneurysm. Particles were released at the
same point in the two geometries. Left figure is for a patient with normal blood pressure under rest
conditions. The right figure is for a patient with high blood pressure under exercise conditions.
Figure 5.3: Relative particle residence time contours across the bulge cross-section. The left figure
is under rest condition for a patient with normal BP. The right figure is for exercise conditions
when the patient has high BP.
Table 5.1: Peak variation of flow parameters in the aneurysm bulge.
Time averaged RMS
Peak Peak Peak Peak
Peak WSS Peak WSS
velocity pressure velocity pressure
normal BP,
0.88 79.62 7.8 0.18 12.3 4.5
rest
high BP, rest 0.92 107.54 10.43 0.26 18.2 6.2
normal BP,
0.94 79.74 11.02 0.34 13.5 6.8
exercise
high BP,
1.12 108.72 12.4 0.68 19.6 10.2
exercise
75
blood pressure in a patient at rest.
76
pressure and wall shear stress in a patient with an aneurysm for normal blood pressure at rest
77
blood pressure in a patient at rest.
78
pressure and wall shear stress in a patient with an aneurysm for high blood pressure at rest
79
blood pressure under exercise conditions.
80
pressure and wall shear stress in a patient with an aneurysm for normal blood pressure under
exercise conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an
instant corresponding to minimum velocity that follows phase ‘a’.
81
blood pressure under exercise conditions.
82
pressure and wall shear stress in a patient with an aneurysm for high blood pressure under exercise
83
CHAPTER 6 Flow Patterns in an Aneurysm Treated with Coil
Embolization

One of the most popular treatment of cerebral aneurysm is the coil embolization method. Coils are
inserted inside the aneurysm bulge which suppress velocities and vortex formation in the bulge
and reduce wall shear stress. In this chapter, mathematically the efficacy of coil embolization
treatment is estimated.
Coils are considered homogeneous and isotropic porous media with the porosity value of
0.735 and permeability value of 1.55 108 m2. The extended Darcy model of Forchheimer and
Brinkman terms is implemented to get the governing differential equations for porous medium.
Figure 6.1: Stream traces of the time averaged flow in a patient after coil embolization. The
elimination of recirculation vortex in the bulge is clearly revealed by the three dimensional plot.
The purpose of coil embolization treatment is to decrease the wall shear stress across the
aneurysm sac. In Figure 6.2 and Figure 6.4 we see that in the aneurysm bulge the velocities have
decreased significantly. Similarly the wall shear stress plot shows a decrement in the wall shear
stress compared to values obtained in a clear medium. The pressure values are of the same order
as the clear medium. The vortex strength also has subsided in the porous medium case. In Figure
6.1 the suppression of the recirculation pattern in the aneurysm is depicted.
The effect of coil embolization treatment remains consistent with the physiological
conditions. In Figure 6.2, Figure 6.4, Figure 6.6 and Figure 6.8 the velocity field inside the
aneurysm bulge has diminished due to the coil insertion. However, in the rest of the artery the
velocity patterns differ depending on the boundary conditions.
Comparing Figure 5.4 and Figure 5.6 with Figure 6.2 and Figure 6.4 one observes a
considerable reduction in wall shear stress and vortex strength. It appears that blood leaves the
aneurysm bulge intact. Blood penetrates inside the porous medium but by the time it reaches to
the aneurysm wall, its velocity is greatly reduced. Moreover the pressure values become uniform
in the bulge region although the magnitude is of the same order as in the clear medium.
The time variation of flow parameters especially wall shear stress is a major factor for the
rupture of cerebral aneurysms. Here in the cases of exercise condition, the frequency of oscillation
is twice the rest condition and might have role in rupture of aneurysm. In contrast, the wall shear
stress magnitudes are reduced to near zero levels and its pulsation will not affect the walls.
According to the non-Newtonian nature of blood when the shear strain rate is higher
viscosity is found to be low. In a clear medium the velocity magnitudes are higher inside the
aneurysm bulge than that of in the case of porous medium. It means that after the coil insertion,
the blood which will be residing in the aneurysm bulge will have lesser velocity and higher
viscosity that will make the blood to clot inside the aneurysm bulge.
From simulation, we observe that the velocity magnitudes inside the aneurysm bulge are
subsided effectively by coil embolization treatment. In addition, the wall shear stress is reduced
up to the near zero levels and its pulsation will also not cause any further damage to the walls.
Table 6.1: Peak variation of flow parameters in the bulge treated with coil embolization.
Time averaged RMS
Peak Peak Peak Peak
Peak WSS Peak WSS
velocity pressure velocity pressure
normal BP,
0.08 79.62 1.3 0.04 12.7 0.1
rest
high BP, rest 0.083 107.71 1.5 0.052 18.4 0.14
normal BP,
0.09 79.93 1.53 0.055 13.6 0.16
exercise
high BP,
0.11 108.5 2.1 0.07 19.6 0.28
exercise
86
shown for normal blood pressure in a patient at rest.
87
pressure at rest conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’
is an instant corresponding to minimum velocity that follows phase ‘a’.
88
shown for high blood pressure in a patient at rest.
89
at rest conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’ is an
instant corresponding to minimum velocity that follows phase ‘a’.
90
shown for normal blood pressure under exercise conditions.
91
pressure under exercise conditions. Phase ‘a’ is time instant when inflow velocity is maximum.
Phase ‘b’ is an instant corresponding to minimum velocity that follows phase ‘a’.
92
shown for high blood pressure under exercise conditions.
93
under exercise conditions. Phase ‘a’ is time instant when inflow velocity is maximum. Phase ‘b’
is an instant corresponding to minimum velocity that follows phase ‘a’.
94
CHAPTER 7 Stress Analysis
In this chapter, the deformation of walls is calculated based on the fluid loading. A fluid-solid
structure analysis is performed and results are calculated for steady and unsteady flow conditions.
Primarily deformation of a tube considering its wall to be single layered and multilayered are
compared. A straight tube (Figure 2.12) and the tube with a bulge in center (Figure 2.13) are
considered.
7.1. Comparison of Deformation between Single Layered and Multilayered Wall Material
In Section 3.7.1, it was explained that the artery wall can be assumed to be made up of single
material with equivalent modulus of elasticity. Here a comparative analysis is performed to verify
the effectiveness of this assumption. In the first computation, single equivalent material is
considered whereas in the second three different layers of materials are taken into account as
described in Figure 2.10. In both cases a tube is considered to calculate wall deformation, fixed at
both the ends and a traction value of 50 Pa is applied on the inner surface.
7.1.1. Deformation of equivalent material

A finite element method analysis is performed and the deformation data is plotted in Figure 7.1.
The elastic modulus is taken 0.462 MPa. Uniform pressure field of 50 Pa is applied at the inner
surface of the tube. The plot shows a symmetric deformation about the middle point.
Figure 7.1: Deformation of a straight tube due to uniform loading at inner surface.
7.1.2. Deformation of a multilayered material
The boundary conditions that were used in Section 7.1, are imposed in this section also. In addition
three different layers are introduced to capture the effect of multilayered artery wall deformation.
The discretization of these layers is performed according to the scheme described in Section 3.7.5
by calculating the distinct elemental matrix based upon the stiffness of that element. The
deformation plot for multilayered artery material is shown in Figure 7.2.
Figure 7.2: Deformation of a tube due to uniform loading at inner surface. The tube material is
comprised of three distinct layers of materials.
96
Figure 7.3: Comparison of wall deformation of a tube between multilayered and single equivalent
layered material. Multilayered material has three distinct layers of materials and in single layered
analysis the artery walls are replaced by an equivalent single material.
The comparison of deformation for the two models is demonstrated in Figure 7.3. The
equivalent material deformation curve matches with the multilayered material deformation curve
up to a great extent. Therefore the mathematical assumption of replacing the artery wall material
by an equivalent single material is expected to be valid.
97
7.2. Analysis for Uniform Flow at Inlet
7.2.1. Wall deformation of a straight tube
The wall shear stress and wall pressure were obtained from FVM code and these entities are
imposed as traction boundary condition to calculate the wall deformation. Blood flows through a
pipe with diameter of 4.5 mm. At the inlet a uniform velocity profile with a value of 0.166 m/s (Re
= 200) is applied, at the outlet zero pressure is imposed and at the wall no-slip condition is used.
Figure 7.4: Variation of wall pressure with respect to axial position for uniform flow at inlet.
The value of wall shear stress gets saturated at 1.15 Pa (Figure 7.5). At the inlet and outlet
the geometry is restricted, namely the displacement of all the nodes at the two extreme boundaries
is zero. At the inner side of the geometry, two traction boundary conditions are applied as described
in Figure 2.11. The direction of wall shear stress is along the axial direction so it is applied as
traction in x direction, whereas the wall pressure is in radial outward direction and it is imposed as
traction in y direction.
98
Figure 7.5: Variation of wall shear stress with respect to axial position for uniform flow.
Using these traction boundary conditions, the wall deformation is calculated. From the wall
deformation data the deformation convergence criteria is verified. If the deformation falls below
the convergence limit, it is considered as final deformation. Otherwise with the help of deformation
data a new geometry is constructed and again wall pressure and wall shear stress are calculated.
On the new geometry the difference of these parameters from their previous values is imposed as
a new boundary condition for solid deformation. These steps are repeated till the wall deformation
satisfies the convergence criteria.
99
7.2.2. Iterations to calculate final deformation
Depending upon the data, a deformed geometry is reconstructed and flow patterns are obtained
again inside the deformed geometry using FVM code. There has been a slight change in pressure
exerted by flowing blood on the artery wall. In order to calculate resultant deformation of wall, the
difference in pressure (current pressure – pressure in previous case) is applied on the walls. The
triangular re-mesh is created using the results obtained in the previous iteration. The new location
of nodes is determined from pervious data and according to that the shape function for each node
is calculated. New pressure variation is plotted in Figure 7.6 below:
Figure 7.6: Variation of modified pressure along axial direction for deformed geometry.
Criteria of convergence of deformation is shown in Equation(7.1).
dmax  max dil  dil 1 (7.1)
where d il is the deformation of any node i at l th iteration.

Using this modified pressure, new traction boundary conditions are imposed on the tube
wall and modified displacements of the nodes are calculated.
Based upon the final deformation data, the deformed geometry is generated and a graphical
comparison with the original undeformed geometry is shown in Figure 7.7.
100
Figure 7.7: Comparison of deformed geometry of a straight tube with original undeformed
geometry for uniform flow at inlet.
Figure 7.8: Spatial variation of velocity, wall pressure and wall shear stress in original and
deformed geometry.
101
7.2.3. Wall deformation of a tube with a bulge in center
Using the FVM code, the wall shear stress and wall pressure were calculated and applied on the
bulge geometry as traction boundary conditions.
Figure 7.9: Variation of pressure at the wall and centerline with respect to axial position for
uniform flow at the inflow plane.
102
Using the deformation data, a solid model is generated and shown below to exhibit the
comparison between deformed geometry and original geometry.
Figure 7.10: Graphical comparison between the deformed geometry of a tube with a bulge in center
and the original undeformed geometry for uniform flow at inlet.
7.3. Pulsatile Flow in a Circular Tube

A circular tube with 4.5 mm diameter is considered to determine the deformation of walls due to
pulsatile flow. At the inlet a time varying velocity profile (7.2) is imposed. Wall pressure and wall
shear stress which are used as the traction boundary conditions on the inner surface of the tube,
are calculated at 10th cycle of oscillation and at a timestep interval of 0.01 seconds. The wall
pressure and wall shear stress are represented in Figure 7.11 and Figure 7.12 respectively at
specific timesteps.
Uin  0.2  0.1sin(2 t) (7.2)
At each of the timestep the wall pressure and wall shear stress data are calculated and this
data is fed into the traction boundary condition for wall deformation. The deformation of wall at
specific timestep is shown in Figure 7.13. Analyzing the data, it can be concluded that during the
acceleration zone the deformation of artery wall is higher than that of during the deceleration zone.
Since the pressure values are elevated in the first half (near the inlet portion) than the second half
(near the outlet portion), the maximum deformation is achieved at a node whose axial position is
47 mm from the inlet.
103
Figure 7.11: Pressure variation along axial direction at selected phases of time for 10th cycle of
oscillation.
Figure 7.12: Wall shear stress variation along axial direction at various timesteps.
104
Figure 7.13: Deformation of a straight tube for pulsatile flow at inlet. The deformations are shown
at selected time instants for 10th cycle of oscillation.
7.4. Pulsatile Flow in a Straight Tube with a Bulge in Center

A circular straight tube with a bulge in center is considered to carry out the deformation of walls
due to pulsatile flow. At the inlet a time varying velocity profile (7.2) is imposed. Wall pressure
and wall shear stress which are used as the traction boundary conditions on the inner surface of
the geometry, are calculated at 10th cycle of oscillation and at a timestep of 0.01 seconds. Wall
shear stress and wall pressure are shown in Figure 7.14 at specific timesteps. The space varying
pressure and wall shear stress are converted into a Fourier series. These Fourier series are used in
the code to calculate the traction in between the nodes of the corresponding element. Then the
force matrix is calculated for each element and all the elemental force matrix are assembled to
form a global force matrix. The subsequent procedure for separation of global stiffness and force
matrix is described in 3.7.3.
105
Figure 7.14: Pressure variation along axial direction at selected phases of time for 10th cycle of
oscillation.
Figure 7.15: Deformed straight tube with a bulge in center for pulsatile flow at inlet. The results
are shown at selected time instants for 10th cycle of oscillation.
106
CHAPTER 8 Conclusions and Future Work
In this chapter, the major conclusions obtained, are listed. Along with these conclusions the areas
where this study can be extended further, are discussed.
8.1. Pulsatile Flow in a Cerebral Aneurysm

This study focuses on the aneurysm initiation, effect of physiological conditions on the patient
with a cerebral aneurysm and the treatment of the aneurysm by coil embolization. Three
dimensional unsteady differential equations are solved using the finite volume method. At the
inflow plane, a time varying velocity boundary condition is imposed for rest and exercise
conditions. At the outlet, pressure boundary condition which varies with time is enforced. The
simulations were started with a healthy artery geometry under normal blood pressure for rest
conditions. In each passing case either the physiological or the geometrical variation was
introduced. The major conclusions observed in this study are listed below:
1. Simulations carried out on a healthy artery geometry exhibit abnormality in wall shear stress
and higher forces on the outer side of the artery near the bend. These entities are giving rise to
the initiation of aneurysm in that zone.
2. The particle residence time is found to be higher in exercise condition that will create adverse
conditions for blood clotting. Propensity of plaque formation is lesser as the blood will not
convert itself into gel. Moreover, heightened wall shear stress will wear off the deposited
plaque that can be beneficial to combat atherosclerosis. These could be the probable reasons
behind the recommendation of physicians to exercise regularly.
3. The efficacy of coil embolization treatment is estimated. After the coil insertion the wall shear
stress and velocity magnitudes reduce to a great extent. The vortex is abolished in the aneurysm
after coil embolization. The pulsation of wall shear stress does not introduce fatigue stress as
the fluctuation amplitude is suppressed significantly. Pressure becomes spatially uniform
across the bulge.
4. During exercise and high blood pressure conditions elevated levels of velocity magnitudes and
wall shear stress are observed in the aneurysm sac. Along with these the formation of vortex
is also seen. Higher amplitude of oscillation of wall shear stress and wall pressure cause the
development of fatigue in the walls of the aneurysm. Moreover, higher pulsation frequency in
high blood pressure under exercise condition case increases fatigue.
8.2. Stress Analysis

Steady and unsteady inflow conditions were imposed for a straight tube and a tube with a bulge at
the center. Galerkin method of weighted residuals was used to discretize the governing differential
equations. Finite element method is implemented to obtain the wall deformation. Wall pressure
and wall shear stress were enforced as the traction boundary conditions for the considered
geometries. Tractions were acquired from the finite volume method code. The major conclusions
obtained in the stress analysis are as follows:
1. Wall deformation considering the arteries to be an equivalent single material matches the
multilayered deformation. Thus the assumption of replacing the artery wall material by a single
material of equivalent modulus of elasticity is valid.
2. Analysis of stationary flow in a straight tube with a bulge at the center suggests that the wall
deformation is a maximum in the bulge region.
3. Maximum and minimum wall deformations are obtained at t  64.8o and t  241.2o
respectively for the pulsatile flow in a straight tube. In the straight tube with a bulge, the
maximum and minimum deformations are achieved at t  68.40 and t  244.8o
respectively.
4. The location of the node at which the maximum wall deformation is achieved, is 46 mm away
from the inlet in the case of uniform flow at the inlet in a straight tube. In a bulge, the location
is 28 mm away from the inlet.
8.3. Future Work

An elementary analysis of fluid-solid interaction is carried out in the current work. However, an
extensive analysis of solid deformation is required. The governing differential equations for fluid
mechanics and solid mechanics need to be solved simultaneously as the deformation of wall will
affect the flow domain. The modified fluid – solid mechanics coupled equation are shown below:

 V
 t

 
 V   V  Vw    p     V  V T


108
where Vw is the wall velocity and other symbols have their usual meaning.
As discussed earlier, blood comprises RBC’s, WBC’s platelets and plasma. Mainly the
RBC’s and WBC’s (known as leukocytes) are suspended in plasma. These particulates will cause
the blood to exhibit a three phase fluid flow behavior. The effect of particulates might be prominent
in low shear stress cases. The analysis of this multiphase flow will give realistic results and their
deviation from single phase analysis can be assessed.
In vivo experiments can be conducted for better understanding the effect of various flow
parameters on hemodynamics. These experiment results will provide a data source for the blood
assumptions to be taken in numerical simulations. In experimental analysis the main challenge is
to construct the complex 3D artery geometries. However with the advancement in the field of 3D
printing this problem will be resolved in the future.
109
Appendix A
At the inlet of the patient specific geometries, the Womersley profile of velocity is imposed. In
this appendix the derivation of Womersley profile under various conditions is described:
A.1 Pulsatile Flow through a Tube (Womersley Solution)

The velocity in the axial direction is denoted by w and the non-dimensional analysis has been
carried out considering clear media of entire flow domain.
w p 1   2 w 1 w 
     (A.1)
t z Re  r 2 r r 
As the flow is oscillatory we could represent the velocity and pressure gradient in following form:

w  Wn  r   ei tn
(A.2)
n 
 
p
   Gn  eint   (p z )n (A.3)
z n  n
In the above equations, n is n . Now substituting Equation (A.2) and (A.3) in Equation (A.1)
and equating both sides for each harmonic will give following equation:
1   2Wn 1 Wn 
inWn  Gn     (A.4)
Re  r 2 r r 
Partial derivative will become total derivative, as Wn is only function of r.
d 2Wn dWn
r2 2
r  r 2  i Re nWn  Re Gn   0 (A.5)
dr dr
Un
The boundary conditions at r  0 is Wn  finite and at r  0.5 , Wn  0 .
On solving Equation (A.4) for n=0, we will get

W0 (r )  Wc 0 (1  4r 2 )
G0 (A.6)
Wc 0 
16 Re
For n  0 , Equation (A.5) can be rearranged as:
d 2U n dU n
r 2
2
r  r 2 (i Re n )U n  0 (A.7)
dr dr
Say r 2 (i Re n )  x2 , then Equation (A.7) will become
d 2U n dU n
x 2
2
x  x 2U n  0 (A.8)
dx dx
This is a Bessel’s differential equation, and the solution would involve Bessel functions of zeroth
order and complex arguments.
U n  C1J 0 ( x)  C2Y0 ( x) (A.9)
Now, substituting the values of U n and x in Equation (A.9)
Wn  
1
i Re n
  
C1J 0 r i Re n  C2Y0 r i Re n  Re Gn    (A.10)
Re Gn
Using the boundary condition, C2 = 0, as r = 0 Y0   and C1  . Hence

J 0 0.5 i Re n 

Wn (r )  Wcn 1 
I 0 r An    
 / 1  1

 (A.11)
 I 0.5 A
 0 n     I 0.5 A
  0  n  

 
1  , B  Gn and A  i Re  .
where, I 0 ( x)  J 0 (ix) , Wcn  Bn 1 
 I 0.5 A
 0 n    n in

n n
The average velocity is defined as:

0.5
1
wavg (t ) 
 (0.5)2  2 rw(t) dr (A.12)
0

wavg (t )   Wavgnei t n
n 
After integrating Equation (A.12) and comparing it with above equation,

 8Wcn

1 1
I1 0.5 An    ; n0
Wavgn


  1  1
  8 2 An I 0 0.5 An

   (A.13)


  I 0 0.5 An  

2Wc 0 ; n0
Volume flow rate will be Q(t )   (0.5)2 wavg (t )
112
 Wc 0 
Wcn

1 1

I1 0.5 An   e 
Q(t )   2  i nt
(A.14)
2 n  
1  1 

  8 2 An I 0 0.5 An  
 
 I 0 0.5 An  

In dimensional form the average velocity can be written as:
Wavgn 
2Wcn

1 1

I1 R An   (A.15)

1  1 

  2 2 An I 0 R An  
 
 I 0 R An  

 
where Wcn  Bn 1 
1  , B  Gn , A  i n .
 I R A
 0 n    n i n n


R is the radius of geometry at inlet.
A.2 Fully Developed Flow through a Tube

The Navier-Stokes equation will resolve into
 u z u u u u  p  1   u z  1  uz  uz 
2 2
  ur z   z  u z z    z    r r  r r 
 2  
 t r r  z     r  2 z 2 
As the flow becomes fully developed, the velocity derivative in z direction will be zero and by
symmetry and momentum equation in r direction, we can say that the rest of the two components
of velocity  ur , u  will be zero. The velocity in axial direction is only dependent on radial
position, therefore partial derivatives will become total derivatives and the resultant equation is:
 1 d  du z   dp
 r  
 r dr  dr   dz
The boundary condition at r = 0, velocity must be finite and at r = R velocity is zero.
The solution of above GDE is:
1 dp r 2
uz   C1 ln r  C2
 dz 4
1 dp R 2
Applying boundary conditions, C1  0 and C2  
 dz 4
113
1 dp R 2  r2   r2 
uz    1    u  1  
 dz 4  R 2  max  R 2 
So the fully developed velocity profile is parabolic in shape as used in Section (3.6.3).
R
1
 R 2 0
(u z )avg  2 r u z dr
1 dp R 2
(u z )avg  
 dz 8
umax  2(uz )avg
114
References
Abe, K., M. Toba, A. Alzoubi, M. Ito, K. A. Fagan, C. D. Cool, N. F. Voelkel, I. F. McMurtry and
M. Oka (2010). "Formation of plexiform lesions in experimental severe pulmonary arterial
hypertension." Circulation 121(25): 2747-2754.
Bazilevs, Y., V. Calo, Y. Zhang and T. J. Hughes (2006). "Isogeometric fluid–structure interaction
analysis with applications to arterial blood flow." Computational Mechanics 38(4-5): 310-322.
Bazilevs, Y., M.-C. Hsu, Y. Zhang, W. Wang, X. Liang, T. Kvamsdal, R. Brekken and J. Isaksen
(2010). "A fully-coupled fluid-structure interaction simulation of cerebral aneurysms."
Computational Mechanics 46(1): 3-16.
Berger, S., L. Talbot and L. Yao (2003). "Flow in curved pipes." Annual review of fluid mechanics
15(1): 461-512.
Boryczko, K., W. Dzwinel and D. A. Yuen (2003). "Dynamical clustering of red blood cells in
capillary vessels." Journal of molecular modeling 9(1): 16-33.
Boussel, L., V. Rayz, C. McCulloch, A. Martin, G. Acevedo-Bolton, M. Lawton, R. Higashida,

W. S. Smith, W. L. Young and D. Saloner (2008). "Aneurysm growth occurs at region of low wall
shear stress patient-specific correlation of hemodynamics and growth in a longitudinal study."
Stroke 39(11): 2997-3002.
Byun, H. S. and K. Rhee (2004). "CFD modeling of blood flow following coil embolization of
aneurysms." Medical Engineering and Physics 26: 755-761.
Date, A. W. (2005). "Solution of transport equations on unstructured meshes with cell-centered

colocated variables. Part I: Discretization." International Journal of Heat and Mass Transfer 48:
1117-1127.
Fernandez, R. C., K. De Witt and M. Botwin (2006). "Pulsatile flow through a bifurcation with
applications to arterial disease." Journal of Biomechanics 9(9): 575-580.
Génevaux, O., A. Habibi and J.-M. Dischler (2003). Simulating Fluid-Solid Interaction. Graphics
Interface, Citeseer.
Giddens, D., C. Zarins and S. Glagov (1990). "Response of arteries to near-wall fluid dynamic
behavior." Applied Mechanics Reviews 43(5S): S98-S102.
Giuma, B., K. Osman and M. Kadir (2009). Numerical modeling of fusiform aneurysm with high
and normal blood pressure. Modelling & Simulation, 2009. AMS'09., IEEE.
Groden, C., J. Laudan, S. Gatchell and H. Zeumer (2001). "Three-dimensional pulsatile flow
simulation before and after endovascular coil embolization of a terminal cerebral aneurysm."
Journal of Cerebral Blood Flow & Metabolism 21: 1464-1471.
Haji-Sheikh, A. and K. Vafai (2004). "Analysis of flow and heat transfer in porous media
embedded inside various-shaped ducts." International Journal of Heat and Mass Transfer 47:
1889–1905.
Hoogstraten, H., J. Kootstra, B. Hillen, J. Krijger and P. Wensing (1996). "Numerical simulation
of blood flow in an artery with two successive bends." Journal of Biomechanics 29(8): 1075-1083.
Kakalis, N. M. P., A. P. Mitsos, J. V. Byrne and Y. Ventikos (2008). "The hemodynamics of

endovascular aneurysm treatment: a computational modelling approach for estimating the
influence of multiple coil deployment." Medical Imaging, IEEE Transactions on 27(6): 814-824.
Khamdaeng, T., J. Luo, J. Vappou, P. Terdtoon and E. Konofagou (2012). "Arterial stiffness
identification of the human carotid artery using the stress–strain relationship in vivo." Ultrasonics
52(3): 402-411.
Khanafer, K. M., P. Gadhoke, R. Berguer and L. B. Joseph (2006). "Modeling pulsatile flow in
aortic aneurysms: effect of non-Newtonian properties of blood." Biorheology, IOS Press 43: 661-
679.
Ku, D. N. and D. P. Giddens (2004). "Pulsatile flow in a model carotid bifurcation."

Arteriosclerosis, Thrombosis, and Vascular Biology 3(1): 31-39.
Lantz, J., J. Renner, T. Länne and M. Karlsson (2015). "Is aortic wall shear stress affected by
aging: an image-based numerical study with two age groups." Medical Engineering & Physics
37(3): 265-271.
Le, T. B., D. R. Troolin, D. Amatya, E. K. Longmire and F. Sotiropoulos (2013). "Vortex

phenomena in sidewall aneurysm hemodynamics: experiment and numerical simulation." Annals
of Biomedical Engineering 41(10): 2157-2170.
Leuprecht, A. and K. Perktold (2001). "Computer simulation of non-Newtonian effects of blood

flow in large arteries." Computer Methods in Biomechanics and Biomechanical Engineering 4:
149-163.
Li, Z. and C. Kleinstreuer (2005). "Fluid-structure interaction effects on sac-blood pressure and
wall stress in a stented aneurysm." Journal of biomechanical engineering 127(4): 662-671.
Morosuk, T. V. (2005). "Entropy generation in conduits filled with porous medium totally and
partially." International Journal of Heat and Mass Transfer 48: 2548–2560.
Motomiya, M. and T. Karino (2004). "Flow patterns in the human carotid artery bifurcation."
Stroke 15(1): 50-56.
Nazemi, M., C. Kleinstreuer and J. Archie (1990). "Pulsatile two-dimensional flow and plaque
formation in a carotid artery bifurcation." Journal of biomechanics 23(10): 1031-1037.
Nield, D. A. and A. Bejan (2006). Convection in porous media, Springer-Verlag, New York
116
Perktold, K., M. Resch and H. Florian (2011). "Pulsatile non-Newtonian flow characteristics in a
three-dimensional human carotid bifurcation model." Journal of Biomechanical Engineering
113(4): 464-475.
Salzar, R. S., M. J. Thubrikar and R. T. Eppink (2005). "Pressure-induced mechanical stress in the
carotid artery bifurcation: a possible correlation to atherosclerosis." Journal of Biomechanics
28(11): 1333-1340.
Sheard, G. J. (2009). "Flow dynamics and wall shear-stress variation in a fusiform aneurism."
Journal of Engg. Mathematics 64: 379-390.
Soulis, J. V., O. P. Lampri, D. K. Fytanidis and G. D. Giannoglou (2011). Relative residence time
and oscillatory shear index of non-Newtonian flow models in aorta. Biomedical Engineering, 2011
10th International Workshop on Biomedical Engineering at Greece, IEEE.
Taib, I., K. Osman, M. Kadir and M. H. Padzillah (2009). Risk of rupture analysis for advanced
level of AAA under combined physiological and physical conditions. Biomedical and
Pharmaceutical Engineering, 2009. ICBPE'09 held at Singapore, IEEE.
Teamah, M. A., W. M. El-Maghlany and M. M. K. Dawood (2011). "Numerical simulation of

laminar forced convection in horizontal pipe partially or completely filled with porous material."
International Journal of Thermal Sciences 50: 1512-1522.
Timité, B., C. Castelain and H. Peerhossaini (2010). "Pulsatile viscous flow in a curved pipe:
Effects of pulsation on the development of secondary flow." International Journal of Heat and
Fluid Flow 31(5): 879-896.
Torii, R., M. Oshima, T. Kobayashi, K. Takagi and T. E. Tezduyar (2008). "Fluid–structure

interaction modeling of a patient-specific cerebral aneurysm: influence of structural modeling."
Computational Mechanics 43(1): 151-159.
Vafai, K. (2011). Porous Media: Applications in Biological Systems and Biotechnology. Boca
Raton, FL 33487-2742, CRC Press, Taylor and Frnacis Group.
Xiang, J., S. K. Natarajan, M. Tremmel, D. Ma, J. Mocco, L. N. Hopkins, A. H. Siddiqui, E. I.

Levy and H. Meng (2011). "Hemodynamic–morphologic discriminants for intracranial aneurysm
rupture." Stroke 42(1): 144-152.
Zhang, Y., W. Chong and Y. Qian (2013). "Investigation of intracranial aneurysm hemodynamics
following flow diverter stent treatment." Medical Engineering & Physics 35(5): 608-615.
117

Abhishek Sharna Thesis PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Abhishek Sharna Thesis PDF

Uploaded by

Copyright:

Available Formats

Effect of Intracranial Pressure and Fluid loading

on the Hemodynamics of a Cerebral Aneurysm

Dedicated to my parents and sisters

deformations are achieved at t  68.40 and t  244.8o respectively.

Certificate ......................................................................................Error! Bookmark not defined.

Table of Contents ................................................................................................................... vii

List of Tables ........................................................................................................................ xvii

Nomenclature ...................................................................................................................... xviii

CHAPTER 1 Introduction and Literature Review ...............................................................1

1.1. Hemodynamics .............................................................................................................4

1.2. Classification of Cardiovascular Diseases .....................................................................4

1.3. Disease Diagnosis and Treatment ..................................................................................7

1.4. Hypertension ............................................................................................................... 10

1.5. Literature Review........................................................................................................ 11

1.6. Objectives of the Present Work ................................................................................... 14

1.7. Thesis Outline ............................................................................................................. 15

CHAPTER 2 Problem Formulation .................................................................................... 17

2.1. Flow Domains ............................................................................................................. 17

2.1.1. Healthy artery geometry ....................................................................................... 17

2.1.2. Artery geometry with an aneurysm ...................................................................... 18

2.2. Governing Differential Equations ................................................................................ 20

2.2.1. Clear medium ...................................................................................................... 21

2.2.2. Porous medium .................................................................................................... 21

2.3. Boundary Conditions .................................................................................................. 22

2.3.1. Inlet boundary conditions ..................................................................................... 22

2.3.2. Rest condition ...................................................................................................... 22

2.3.3. Exercise condition ................................................................................................ 23

2.3.4. Outlet boundary conditions .................................................................................. 24

2.3.5. Normal blood pressure condition .......................................................................... 24

2.3.6. High blood pressure condition .............................................................................. 25

2.3.7. Boundary conditions at wall ................................................................................. 26

2.4. Properties of Blood ..................................................................................................... 27

2.5. Biomechanics .............................................................................................................. 29

CHAPTER 3 Solution Methodology .................................................................................... 33

3.1. Discretization .............................................................................................................. 33

3.2. Numerical Algorithm .................................................................................................. 36

3.3. Numerical Solver ........................................................................................................ 37

3.3.1. Code parallelization ............................................................................................. 37

3.4. Flow Parameters ......................................................................................................... 38

3.5. Grid Generation .......................................................................................................... 39

3.6. Validation of FVM Code............................................................................................. 41

3.6.1. Steady flow in a 90o bend tube ............................................................................. 41

3.6.2. Pulsatile unsteady flow in a 90o bend tube ............................................................ 42

3.6.3. Developing flow in a straight tube ........................................................................ 44

3.7. Solution Methodology for Biomechanics .................................................................... 47

3.7.1. Calculation of equivalent elastic modulus ............................................................ 47

3.7.2. Governing differential equations .......................................................................... 48

3.7.3. Discretization ....................................................................................................... 49

3.7.4. 3D Discretization ................................................................................................. 54

3.7.5. Effect of multilayers of the artery wall ................................................................. 56

CHAPTER 4 Flow Patterns in a Healthy Patient Specific Geometry ................................ 59

4.1. Results and Discussion ................................................................................................ 60

CHAPTER 5 Flow Patterns in a Patient with an Aneurysm .............................................. 71

5.1. Vortex Formation inside the Aneurysm Bulge ............................................................. 71

5.2. Results and Discussion ................................................................................................ 72

5.3. Relative Particle Residence Time ................................................................................ 73

5.3.1. Quantification of relative particle residence time .................................................. 73

CHAPTER 6 Flow Patterns in an Aneurysm Treated with Coil Embolization ................. 85

6.1. Results and Discussion ................................................................................................ 85

CHAPTER 7 Stress Analysis................................................................................................ 95

7.1.1. Deformation of equivalent material ...................................................................... 95

7.1.2. Deformation of a multilayered material ................................................................ 96

7.2. Analysis for Uniform Flow at Inlet .............................................................................. 98