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**ﬁnite element modeling of blood ﬂow and pressure in arteries
**

Irene E. Vignon-Clementel

a

, C. Alberto Figueroa

a

,

Kenneth E. Jansen

c

, Charles A. Taylor

a,b,

*

a

Department of Mechanical Engineering, Stanford University, E350 Clark Center, 318 Campus Drive,

Stanford 94305-5431, CA 94305, USA

b

Department of Bioengineering and Surgery, Stanford University, E350 Clark Center, 318 Campus Drive,

Stanford 94305-5431, CA 94305, USA

c

Scientiﬁc Computation Research Center and the Department of Mechanical, Aeronautical and Nuclear Engineering,

Rensselaer Polytechnic Institute, Troy, NY 12180, USA

Received 23 November 2004; received in revised form 8 February 2005; accepted 13 April 2005

Abstract

Flow and pressure waves emanate from the heart and travel through the major arteries where they are damped, dis-

persed and reﬂected due to changes in vessel caliber, tissue properties and branch points. As a consequence, solutions to

the governing equations of blood ﬂow in the large arteries are highly dependent on the outﬂow boundary conditions

imposed to represent the vascular bed downstream of the modeled domain. The most common outﬂow boundary con-

ditions for three-dimensional simulations of blood ﬂow are prescribed constant pressure or traction and prescribed

velocity proﬁles. However, in many simulations, the ﬂow distribution and pressure ﬁeld in the modeled domain are

unknown and cannot be prescribed at the outﬂow boundaries. An alternative approach is to couple the solution at

the outﬂow boundaries of the modeled domain with lumped parameter or one-dimensional models of the downstream

domain. We previously described a new approach to prescribe outﬂow boundary conditions for simulations of blood

ﬂow based on the Dirichlet-to-Neumann and variational multiscale methods. This approach, termed the coupled mul-

tidomain method, was successfully applied to solve the non-linear one-dimensional equations of blood ﬂow with a vari-

ety of models of the downstream domain. This paper describes the extension of this method to three-dimensional ﬁnite

element modeling of blood ﬂow and pressure in the major arteries. Outﬂow boundary conditions are derived for any

downstream domain where an explicit relationship of pressure as a function of ﬂow rate or velocities can be obtained at

the coupling interface. We developed this method in the context of a stabilized, semi-discrete ﬁnite element method.

0045-7825/$ - see front matter Ó 2005 Elsevier B.V. All rights reserved.

doi:10.1016/j.cma.2005.04.014

*

Corresponding author. Address: Department of Mechanical Engineering, Stanford University, E350 Clark Center, 318 Campus

Drive, Stanford, CA 94305, USA. Tel.: +1 650 725 6128; fax: +1 650 725 9082.

E-mail address: taylorca@stanford.edu (C.A. Taylor).

Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

www.elsevier.com/locate/cma

Flow rate and pressure distributions are shown for diﬀerent boundary conditions to illustrate the dramatic inﬂuence of

alternative boundary conditions on these quantities.

Ó 2005 Elsevier B.V. All rights reserved.

Keywords: Blood ﬂow; Pressure; Boundary conditions; Coupled multidomain method; Finite elements

1. Introduction

In normal and disease states in children and adults, quantiﬁcation of three-dimensional ﬂow phenomena

and pressure ﬁelds is important to understand the response of the cardiovascular system to biomechanical

forces [1]. In the development of the circulatory system in normal subjects and congenital heart disease pa-

tients, ﬂow modulates diameter and pressure controls wall thickness [2,3]. In older subjects, the initiation

and progression of atherosclerotic and aneurismal disease is directly aﬀected by the complex three-dimen-

sional ﬂuid mechanical environment of the major arteries [4,5]. Moreover, the ability to adequately simulate

ﬂow and pressure is needed to model the performance of devices such as heart valves, LVADs (left ventric-

ular assist devices), ﬁlters, stents and stent-grafts. Non-invasive three-dimensional ﬂow and pressure data

can also provide important information to determine the signiﬁcance of an obstruction or predict the out-

come of a procedure [6,7].

In recent years, remarkable progress has been made in simulating blood ﬂow in realistic anatomical

models constructed from three-dimensional medical imaging data. Arguably, accurate anatomic models

are of primary importance in simulating blood ﬂow. However, as we demonstrate in this paper, realistic

boundary conditions are equally important in computing velocity and pressure ﬁelds. Yet, this subject

has received far less attention than image-based model construction for three-dimensional simulations.

In contrast, signiﬁcant progress has been made in devising outﬂow boundary conditions for solving the

one-dimensional equations of blood ﬂow in elastic vessels. For example, Stergiopulos solved the non-linear

one-dimensional equations of blood ﬂow in a comprehensive model of the arterial system using a lumped

parameter model of the vasculature downstream of each branch in his numerical model [8]. Several groups

have developed and analyzed the coupling of one-dimensional equations with lumped models [9–12]. In

contrast to methods coupling the one-dimensional equations of blood ﬂow to lumped parameter models,

Olufsen developed a distributed downstream model based on calculating the input impedance of an asym-

metric binary fractal tree using WomersleyÕs linear wave theory [13,14] and an algorithm for computing the

impedance of a vascular network ﬁrst proposed by Taylor [15]. OlufsenÕs approach was to generate a fractal

tree for each outlet starting from a vessel that matched the diameter of the outlet and diminished in size

with each successive generation of vessels until a ﬁxed terminal vessel size was attained. With this method

an impedance for each outlet of the upstream numerical model was computed naturally from linear wave

theory and branching laws. OlufsenÕs distributed model of the downstream vasculature enabled the repre-

sentation of more realistic ﬂow and pressure waveforms than those obtained with lumped parameter mod-

els [16]. Steele and Taylor used a modiﬁed version of OlufsenÕs impedance boundary condition to model

blood ﬂow at rest and during simulated exercise conditions [17]. In this case, vascular networks were as-

signed to the outlets of a model of the abdominal aorta, modiﬁed to represent the resting ﬂow distribution

of 11 diﬀerent subjects and then dilated to simulate the eﬀects of lower limb exercise. Vignon and Taylor

developed a multidomain approach to couple one-dimensional equations to diﬀerent lumped and one-

dimensional boundary conditions [18]. While these one-dimensional methods can be used to compute ﬂow

rate and mean pressure, by design, they cannot be used to simulate complex three-dimensional ﬂow phe-

nomena and pressure losses. Three-dimensional numerical methods have been used to compute velocity

ﬁelds and quantify shear forces acting on the surface of blood vessels. However, since most three-dimen-

sional models of blood ﬂow use zero or constant pressure, zero traction, or prescribed velocity proﬁles

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3777

as outlet boundary conditions, blood pressure is not computed accurately and notably absent from reports

of hemodynamic investigations [19–24].

For simulations of blood ﬂow in large arteries, the outlet boundary conditions represent the downstream

vasculature including smaller arteries, arterioles, capillaries, venules and veins returning blood to the heart.

Clearly, the vast extent and complexity of the circulation precludes a three-dimensional representation of

the entire circuit, yet ignoring the eﬀect of the downstream circulation results in grossly inaccurate predic-

tions of velocity and pressure ﬁelds for many problems where the distribution of ﬂow between the major

arteries is unknown. If zero or equal pressures or tractions are used for diﬀerent outlets, the ﬂow split will

be dictated solely by the resistance to ﬂow in the branches of the domain of interest, neglecting the

dominant eﬀect of the resistance of the downstream vascular beds. An alternative approach is to utilize

three-dimensional models for the major arteries where high-ﬁdelity information is needed, and reduced-

order models to represent the remainder of the system. While closed-loop models are optimal, a simpler

approach is to directly represent the vasculature of the small arteries and arterioles using zero-dimensional

or one-dimensional models. These models can be terminated at the level of the capillary vessels where an

assumption of constant pressure is reasonable. Several groups [6,25–33] have successfully coupled three-

dimensional models to either resistances or more sophisticated zero-dimensional models (lumped models),

but this coupling has been performed iteratively, and generally applied to geometries with few outlets and

low resistances (as seen in the pulmonary vasculature). A further limitation of these methods to couple

three-dimensional and zero-dimensional models is the fact that there is no direct relationship between

the anatomy of the downstream vascular bed and the lumped parameters resulting in diﬃculties in speci-

fying these parameters and relating them to subsequent physiologic or pathophysiologic changes in the

downstream vasculature. In addition, for many simulations based on three-dimensional imaging data,

anatomic information is available for vessels downstream of the primary region of interest. The incorpora-

tion of such data would improve the accuracy of the models of the downstream vasculature.

Methods to couple three-dimensional and one-dimensional models were ﬁrst described by Formaggia

et al. [34,35]. While great progress was made in these landmark papers, the coupling was performed for sim-

ple geometries and iteratively. Based on our experience, implicit coupling signiﬁcantly improves conver-

gence, especially for models with multiple outlets. In addition, these papers did not include coupling

between three-dimensional domains and complex vascular networks as have been incorporated in one-

dimensional numerical solutions of blood ﬂow in arteries. Since the vascular bed from the major arteries

to the capillaries can include tens of millions of blood vessels, non-linear one-dimensional models would

be intractable. However, using linear wave propagation theory the input impedance of the downstream vas-

cular bed can be computed for large complex vascular trees. A method to prescribe the impedance (calcu-

lated using linear wave theory) of these downstream vascular beds at the outlets of three-dimensional

models would enable the speciﬁcation of realistic boundary conditions for three-dimensional simulations

of blood ﬂow and pressure.

While inadequate outﬂow boundary conditions and rigid-wall models are the main impediments to the

realistic prediction of pressure in three-dimensional blood ﬂow simulations, in this paper we focus on the

ﬁrst issue and do not address the issue of wall deformability in the three-dimensional domain. We describe a

new method to prescribe outﬂow boundary conditions in the context of the ﬁnite element method as this

method is particularly well suited for handling complex geometries and boundary conditions inherent in

modeling blood ﬂow [24]. The approach we describe is based on the Dirichlet-to-Neumann (DtN) [36]

and the variational multiscale [37] methods and is an extension of the 1D coupled multidomain approach

we successfully applied with a variety of models of the downstream domain [18]. For one-dimensional prob-

lems, we demonstrated that a DtN map can be calculated for the impedance of complex vascular trees and

that this approach incorporates naturally occurring wave reﬂections from a downstream bed. Wave prop-

agation in transient and periodic states was simulated and the importance of selecting appropriate bound-

ary conditions was demonstrated for one-dimensional simulations of blood ﬂow. We also noted that the

3778 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

best boundary condition for cardiovascular applications is not the one that exhibits no wave reﬂection,

since wave reﬂections naturally arising from downstream beds (from bifurcations, tapering, and variations

in wall properties) should propagate back upstream into the numerical domain. We concluded that, at pres-

ent, impedance-based boundary conditions are the best approach for incorporating natural sites of wave

reﬂection in the downstream vasculature.

In this paper we present a coupled multidomain approach for three-dimensional ﬁnite element simula-

tions of blood ﬂow and pressure. Given the computational expense of three-dimensional numerical meth-

ods and the resolution limits imposed by current imaging technologies, we constrain the three-dimensional

domain to the major arteries, and model the downstream domains with simpler models (Fig. 1). The outlet

boundary conditions are implemented implicitly resulting in good stability and convergence properties at

physiologic pressures. The organization of the paper will begin with the description of our coupled multi-

domain method in three-dimensions and its specialization to resistance and impedance boundary condi-

tions. We then demonstrate this new method on a straight, cylindrical blood vessel, a bifurcation model

with a stenosis on one side, and a subject-speciﬁc model of the human abdominal aorta.

2. Methods

2.1. Governing equations (strong form)

The method described can be applied to conservative as well as advective formulations of the incom-

pressible Navier–Stokes equations, and was successfully implemented in both cases. We proceed by deﬁning

the spatial domain as X and its boundary as C. The three-dimensional equations for the ﬂow of an incom-

pressible Newtonian ﬂuid consist of the three momentum balance equations and the continuity equation

(written here in advective form) subject to suitable initial and boundary conditions

Fig. 1. Illustration of the ‘‘Coupled Multidomain Method’’, where information from the downstream (analytical) domain is

incorporated in the upstream (computational) domain through a boundary map. This approach accommodates a variety of

downstream models ranging from pure resistive to complex electrical analogs and impedance models.

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3779

q~v

;t

þq~v Á r~v ¼ Àrp þdivðs

$

Þ þ

~

f

divð~vÞ ¼ 0

s

$

¼ 2lD

$

with D

$

¼

1

2

ðr~v þr~v

T

Þ.

ð1Þ

The primary variables are the ﬂuid velocity ~v ¼ ðv

x

; v

y

; v

z

Þ and the pressure p. The density of the ﬂuid is gi-

ven by q (assumed constant), the external force by

~

f , and the viscosity by l (assumed constant).

In regards to boundary conditions, the boundary C of the spatial domain can be split into a Dirichlet

partition C

g

and a Neumann partition C

h

such that (C = oX = C

g

[ C

h

; C

g

\ C

h

= ;). Considering this,

the velocity at the inlet(s) of the domain is typically speciﬁed as

~vð~x; tÞ ¼~v

in

ð~x; tÞ ~x 2 C

in

& C

g

. ð2Þ

A no-slip boundary condition is imposed on the walls (surfaces that are neither inlets nor outlets). We dis-

cuss outﬂow boundary conditions subsequently. The initial conditions for this problem are given by

~vð~x; 0Þ ¼~v

0

ð~xÞ ~x 2 X. ð3Þ

2.2. Weak form

We deﬁne the trial solution and weighting function spaces for the semi-discrete formulation as

S¼ f~vj~vðÁ; tÞ 2 H

1

ðXÞ

n

sd

; t 2 ½0; T;~vðÁ; tÞ ¼~g on C

g

g;

W ¼ f~wj~wðÁ; tÞ 2 H

1

ðXÞ

n

sd

; t 2 ½0; T; ~wðÁ; tÞ ¼

~

0 on C

g

g;

P¼ fpjpðÁ; tÞ 2 H

1

ðXÞ; t 2 ½0; Tg;

ð4Þ

where H

1

represents the usual Sobolev space of functions with square-integrable values and ﬁrst derivatives

in X; n

sd

represents the number of spatial dimensions and ~g represents the prescribed Dirichlet boundary

condition.

The weak form reads: ﬁnd ~v 2 S and p 2 P such that for every ~w 2 W and q 2 P

B

G

ð~w; q;~v; pÞ ¼ 0;

B

G

ð~w; q;~v; pÞ ¼

_

X

~w Á ðq~v

;t

þq~v Á r~v À

~

f Þ þr~w : ðÀp I

$

þs

$

Þ

_ _

d~x

À

_

X

rq Á ~vd~x À

_

C

h

~w Á ðÀp I

$

þs

$

Þ Á ~nds þ

_

C

q~v Á ~nds.

ð5Þ

2.3. Coupled multidomain method

We adopt the following approach to derive appropriate outﬂow boundary conditions [18,37]. First, we

divide the spatial domain X into an upstream ‘‘numerical’’ domain

´

X, and a downstream ‘‘analytic’’ do-

main X

0

such that

´

X \ X

0

¼ ; and

´

X [ X

0

¼ X. The boundary that separates these domains is deﬁned

as C

B

(Fig. 2). We deﬁne a disjoint decomposition of the variables, for example for the unknown solution

vector, Uð~x; tÞ ¼ ½~v; p

T

, ð~x; tÞ 2 X Â½0; T,

U ¼

´

U þU

0

with

´

Uj

X

0 ¼ 0 and U

0

j

^

X

¼ 0 ð6Þ

3780 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

so that

U ¼

´

Uj~x 2

´

X; U

0

j~x 2 X

0

and

´

U ¼ U

0

~x 2 C

B

_ _

. ð7Þ

Note also that

~n

0

¼ À

^

~n. ð8Þ

We use a similar decomposition for the weighting functions, and insert these expressions into the previous

variational form:

_

X

ð

^

~w þ~w

0

Þ Á qð

^

~v

;t

þ~v

0

;t

Þ þqð

^

~v þ~v

0

Þ Á rð

^

~v þ~v

0

Þ À

~

f

_ _

þðr

^

~w þr~w

0

Þ : Àð^p þp

0

Þ I

$

þð^s þs

0

Þ

_ _

d~x

À

_

C

h

ð

^

~w þ~w

0

Þ Á Àð^p þp

0

Þ I

$

þð^s

$

þ s

$

0

Þ

_ _

Á ~nds À

_

X

ðr^q þrq

0

Þ Á ð

^

~v þ~v

0

Þ d~x

þ

_

C

ð^q þq

0

Þð

^

~v þ~v

0

Þ Á ~nds ¼ 0. ð9Þ

The disjoint nature of this expression is used to derive a new variational form for the numerical domain.

Speciﬁcally, since

´

U vanishes on X

0

and U

0

vanishes on

´

X (and similarly for the weighting functions),

we ﬁnd:

Fig. 2. The spatial domain is divided between the upstream numerical domain

´

X (main model) and the downstream analytic domain

´

X ¼ [

i

X

0

i

(here the trees), separated by the coupling boundary C

B

¼ [

i

C

Bi

(here in green).

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3781

_

^

X

^

~w Á ðq

^

~v

;t

þq

^

~v Á r

^

~v À

~

f Þ þr

^

~w : ðÀ^p I

$

þ^s

$

Þ d~x À

_

^

C

h

^

~w Á ðÀ^p I

$

þ^s

$

Þ Á

^

~nds

þ

_

X

0

~w

0

Á ðq~v

0

;t

þq~v

0

Á r~v

0

À

~

f Þ þr~w

0

: ðÀp

0

I

$

þs

$

0

Þ d~x À

_

C

0

h

~w

0

Á ðÀp

0

I

$

þs

$

0

Þ Á ~n

0

ds À

_

^

X

r^q Á

^

~vd~x

þ

_

^

C

^q

^

~v Á

^

~nds À

_

X

0

rq

0

Á ~v

0

d~x þ

_

C

0

q

0

~v

0

Á

~

n

0

ds ¼ 0. ð10Þ

Now since (1) holds in X

0

, we obtain the original variational form specialized to the numerical domain

´

X

with the addition of boundary terms accounting for the interface to the analytic domain, X

0

_

^

X

^

~w Á ðq

^

~v

;t

þq

^

~v Á r

^

~v À

~

f Þ þr

^

~w : ðÀ^p I

$

þ^s

$

Þ d~x À

_

^

C

h

^

~w Á ðÀ^p I

$

þ^s

$

Þ Á

^

~nds

þ

_

C

B

~w

0

Á ðÀp

0

I

$

þs

$

0

Þ Á ~n

0

ds À

_

^

X

r^q Á

^

~vd~x þ

_

^

C

^q

^

~v Á

^

~nds À

_

C

B

q

0

~v

0

Á ~n

0

ds ¼ 0. ð11Þ

Here we introduce an approximation to be able to quantify the terms above that come from the down-

stream domain:

ðÀp

0

I

$

þs

0

$

Þj

C

B

% ½M

$

m

ð~v

0

; p

0

Þ þH

$

m

C

B

;

~v

0

j

C

B

% ½

~

M

c

ð~v

0

; p

0

Þ þ

~

H

c

C

B

.

ð12Þ

The operators M ¼ ½M

$

m

;

~

M

c

C

B

and H ¼ ½H

$

m

;

~

H

c

C

B

are deﬁned on the X

0

domain based on the chosen mod-

el to represent the downstream domain (diﬀerent examples are provided subsequently).

Then using Eqs. (7) and (8), we enforce the continuity of the momentum and mass ﬂuxes across C

B

_

C

B

^

~w Á ðM

$

m

ð

^

~v; ^pÞ þH

$

m

Þ Á

^

~nds ¼ À

_

C

B

~w

0

Á ðM

$

m

ð~v

0

; p

0

Þ þH

$

m

Þ Á ~n

0

ds;

_

C

B

^qð

~

M

c

ð

^

~v; ^pÞ þ

~

H

c

Þ Á

^

~nds ¼ À

_

C

B

q

0

ð

~

M

c

ð~v

0

; p

0

Þ þ

~

H

c

Þ Á ~n

0

ds.

ð13Þ

We thus approximate the boundary terms on C

B

in the weak form (11) by

_

C

B

~w

0

Á ðÀp

0

I

$

þs

$

0

Þ Á ~n

0

ds % À

_

C

B

^

~w Á ðM

$

m

ð

^

~v; ^pÞ þH

$

m

Þ Á

^

~nds;

_

C

B

q

0

~v

0

Á ~n

0

ds % À

_

C

B

^qð

~

M

c

ð

^

~v; ^pÞ þ

~

H

c

Þ Á

^

~nds.

ð14Þ

The resulting weak form for the multidomain method is then

_

^

X

^

~w Á ðq

^

~v

;t

þq

^

~v Á r

^

~v À

~

f Þ þr

^

~w : ðÀ^p I

$

þ^s

$

Þ d~x À

_

^

C

h

^

~w Á ðÀ^p I

$

þ^s

$

Þ Á

^

~nds;

À

_

C

B

^

~w Á ðM

$

m

ð

^

~v; ^pÞ þH

$

m

Þ Á

^

~nds À

_

^

X

r^q Á

^

~vd~x þ

_

^

C

^q

^

~v Á

^

~nds þ

_

C

B

^qð

~

M

c

ð

^

~v; ^pÞ þ

~

H

c

Þ Á

^

~nds ¼ 0.

ð15Þ

We see that the solution in the numerical domain depends on operators deﬁned by the mathematical model

chosen to represent the physics of the downstream domain (see the terms in boxes) but not the solution

variable, ~v

0

and p

0

in the downstream domain.

3782 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

2.4. Derivation of the operators depending on the model chosen to represent the physics

in the downstream domain

In selecting a mathematical model of the downstream domain X

0

, we have the goal of obtaining a rep-

resentation formula whereby the solution on the boundary C

B

can be obtained as a function of the problem

on the interior of the analytic domain and the outlet(s) of the analytic domain. Fundamentally, this repre-

sentation formula will depend on the approximations we introduce in treating the downstream domain. We

consider two possibilities, namely zero-dimensional models and one-dimensional wave propagation theory.

In those cases, we will have a relationship between mean pressure and ﬂow rate at C

B

, but this method can

incorporate more general relationships between the primary variables or functions of them—namely, full

traction relationships instead of just the normal component.

2.4.1. Resistance boundary condition

We ﬁrst present the results for the simplest zero-dimensional model for the downstream domain, the

resistance. The general concept of resistance is to deﬁne a constant relationship between mean pressure

and ﬂow rate P = QR [38], consistent with Poiseuille ﬂow where the ﬂow is fully developed (gradients in

the axial direction are zero). We make the assumption that pressure in the downstream domain is constant

over the cross-sectional area of the inlet boundary C

B

so that

p

0

À~n

0

Á s

$

0

Á ~n

0

¼ p

0

À0 ¼

_

C

B

p

0

ds

_

C

B

ds

¼ ÀR

_

C

B

~v

0

Á ~n

0

ds. ð16Þ

Therefore, the operators M and H are deﬁned as

½M

$

m

ð~v

0

; p

0

Þ þH

$

m

C

B

¼ R

_

C

B

~v

0

Á ~n

0

ds I

$

þs

$

0

À~n

0

Á s

$

0

Á ~n

0

I

$

_ _¸

¸

¸

¸

C

B

;

½

~

M

c

ð~v

0

; p

0

Þ þ

~

H

c

C

B

¼~v

0

j

C

B

.

ð17Þ

Note that the sign of the resistance part of the operators changes if the face is an inlet or an outlet. Here, C

B

is an inlet for X

0

and an outlet for

´

X. In this simple resistance case, the ﬁrst box representing a term on the

coupling interface C

B

in (15) is modiﬁed as follows:

_

C

B

^

~w Á ðM

$

m

ð

^

~v; ^pÞ þH

$

m

Þ Á

^

~nds ¼ À

_

C

B

^

~w Á

^

~n R

_

C

B

^

~v Á

^

~nds þ

^

~n Á ^s

$

Á

^

~n

_ _

ds þ

_

C

B

^

~w Á ^s

$

Á

^

~nds. ð18Þ

2.4.2. Impedance boundary condition

An example of a memory map is the impedance model, which is analogous to the concept of impedance

in electricity. In this paper the downstream domain is approximated using WomersleyÕs linear wave theory

[13,14] in an asymmetric fractal tree to derive a one-dimensional impedance Z(t) assuming periodicity in

time. Note that in this theory ~n Á s

$

Á~n is negligible. We can then derive for an inlet face:

p

0

À~n

0

Á s

$

0

Á ~n

0

% p

0

À0 ¼

_

C

B

p

0

ds

_

C

B

ds

¼ À

1

T

_

t

tÀT

Zðt Àt

1

Þq

0

ðt

1

Þ dt

1

¼ À

1

T

_

t

tÀT

Zðt Àt

1

Þ

_

C

B

~v

0

ðt

1

Þ Á ~n

0

ds dt

1

. ð19Þ

The ﬂow rate at time t depends on the history of the pressure over one period. The representation formula

for the operators is obtained as

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3783

½M

$

m

ð~v

0

; p

0

Þ þH

$

m

C

B

¼

1

T

_

t

tÀT

Zðt Àt

1

Þ

_

C

B

~v

0

ðt

1

Þ Á ~n

0

ds dt

1

I

$

þs

$

0

À~n

0

Á s

$

0

Á ~n

0

I

$

_ _¸

¸

¸

¸

C

B

;

½

~

M

c

ð~v

0

; p

0

Þ þ

~

H

c

C

B

¼~v

0

j

C

B

.

ð20Þ

As before, note that the sign of the impedance part of the operators changes if the face is an inlet or an

outlet. Here, C

B

is an inlet for X

0

and an outlet for

^

X. For this memory case, the ﬁrst box on the coupling

interface C

B

in (15) is modiﬁed as follows:

_

C

B

^

~w Á ðM

$

m

ð

^

~v; ^pÞ þH

$

m

Þ Á

^

~nds ¼ À

_

C

B

^

~w Á

^

~n

1

T

_

t

tÀT

Zðt Àt

1

Þ

_

C

B

^

~vðt

1

Þ Á

^

~nds dt

1

þ

^

~n Á ^s

$

Á

^

~n

_ _

ds

þ

_

C

B

^

~w Á ^s

$

Á

^

~nds. ð21Þ

Remark 1. Pressure and velocities on the boundary become unknown solution variables. Thus this method

enforces an implicitly coupled boundary condition.

Remark 2. The method described above can also be used when the impedance is derived from a (zero-

dimensional) lumped parameter model.

Remark 3. The components of the natural boundary integrals over C

h

in (5) that are not explicitly

described above in (18) and (21) are computed directly from the current solution

_

C

B

^

~w Á ^s

$

Á

^

~n À

^

~w Á

^

~nð

^

~n Á ^s

$

Á

^

~nÞ ds. ð22Þ

These so-called ‘‘consistent boundary conditions’’ are not in fact boundary conditions since they are di-

rectly computed from the solution variables. For a description of this as well as many alternative outﬂow

boundary conditions see Gresho and Sani [39]. In particular, the magnitude of the tangential tractions

which arise in Eqs. (18) and (21) are very small relative to other terms and could be neglected with minimal

eﬀect on accuracy and stability.

Remark 4. For simplicity, we omit the ^ superscript from the ﬁeld variables and the corresponding spaces

in the subsequent sections.

2.5. Finite element discretization

We employ a stabilized semi-discrete ﬁnite element method, based on ideas developed in Brooks and

Hughes [40], Franca and Frey [41], Taylor et al. [24]. The discrete trial solution and weighting function

spaces for the semi-discrete formulation are given by

S

k

h

¼ f~vj~vðÁ; tÞ 2 H

1

ðXÞ

n

sd

; t 2 ½0; T;~vj

~x2X

e

2 P

k

ðX

e

Þ

n

sd

;~vðÁ; tÞ ¼

^

~g on C

g

g;

W

k

h

¼ f~wj~wðÁ; tÞ 2 H

1

ðXÞ

n

sd

; t 2 ½0; T; ~wj

x2X

e

2 P

k

ðX

e

Þ

n

sd

; ~wðÁ; tÞ ¼

~

0 on C

g

g;

P

k

h

¼ fpjpðÁ; tÞ 2 H

1

ðXÞ; t 2 ½0; T; pj

x2X

e

2 P

k

ð

X

e

Þg.

ð23Þ

Considering this, the weak form becomes: ﬁnd ~m 2 S

k

h

and p 2 P

k

h

such that for every ~w 2 W

k

h

and

q 2 P

k

h

3784 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

B

G

ð~w; q;~v; pÞ ¼ 0;

B

G

ð~w; q;~v; pÞ ¼

_

X

f~w Á ðq~v

;t

þq~v Á r~v À

~

f Þ þr~w : ðÀp I

$

þs

$

Þgd~x À

_

X

rq Á ~vd~x

À

_

C

h

~wðÀp I

$

þs

$

Þ~nds þ

_

CÀC

B

q~v Á ~nds

À

_

C

B

~wðM

$

m

ð~v; pÞ þH

$

m

Þ Á ~ndC þ

_

C

B

qð

~

M

c

ð~v; pÞ þ

~

H

c

Þ Á ~ndC.

ð24Þ

In this equation, the superscripts h, k of the discrete approximation of the continuous variables have been

omitted for simplicity. Note that the boundary terms are identiﬁed in the box. In order to stabilize the

Galerkin method, the formulation becomes [24,42]:

Find ~v 2 S

k

h

and p 2 P

k

h

such that for every ~w 2 W

k

h

and q 2 P

k

h

Bð~w; q;~v; pÞ ¼ 0;

Bð~w; q;~v; pÞ ¼ B

G

ð~w; q;~v; pÞ þ

n

el

e¼1

_

X

e

fð~v Á rÞ~w Á s

M

~

Lð~v; pÞ þrÁ ~ws

C

rÁ ~vgd~x

þ

n

el

e¼1

_

X

e

f~w Á ðq~v

D

Ár~vÞ þð

~

Lð~v; pÞ Á r~wÞ Á ðs

~

Lð~v; pÞ Á r~vÞgd~x

þ

n

el

e¼1

_

X

e

rq Á

s

M

q

~

Lð~v; pÞ d~x;

ð25Þ

~

Lð~v; pÞ represents the residual vector of the momentum equation:

~

Lð~v; pÞ ¼ q~v

;t

þq~v Á r~v þrp ÀrÁ s

$

À

~

f . ð26Þ

And ~v

D

is a conservation-restoring advective velocity whose expression is given by

~v

D

¼ À

s

M

q

~

Lð~v; pÞ. ð27Þ

The stabilization parameters are deﬁned as follows:

s

M

¼

1

ﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃ

ð2c

1

=DtÞ

2

þ~v Á g

$

~v þc

2

m

2

ðg

$

: g

$

þx

2

Þ

_ ;

s

C

¼

q

8s

M

trðg

$

Þ

C

s

C

c

1

and s ¼

s

M

ﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃ

~

Lð~v; pÞ Á g

$

Á

~

Lð~v; pÞ

_ ;

ð28Þ

where c

1

and c

2

are constants deﬁned from the one-dimensional scalar model problem of the advection–dif-

fusion equation. x is the frequency of rotation of the reference frame, C

s

C

is a scale factor for s

C

, and g

$

is

the covariant metric tensor

g

$

¼ ð

~

n

;~x

Þ

T

~

n

;~x

. ð29Þ

These non-linear equation (25) are then solved using methods described in [42,43]. The ‘‘coupled multi-

domain method’’ was implemented for diﬀerent boundary conditions in both the advective and the conserva-

tive forms, explicitly (in the residual only) and implicitly (in both the tangent matrix and the residual). We

observed good numerical convergence and stability properties. In addition, we veriﬁed that the relationships

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3785

we imposed as boundary conditions were numerically satisﬁed and checked for mass conservation between

the inlet and outlets. Subsequent to the veriﬁcation studies, we solved a series of problems to demonstrate

that realistic pressure ﬁelds could be computed and to compare and contrast impedance, resistance and con-

stant pressure boundary conditions. This is described fully in the next section.

3. Results

In the examples below, the proﬁle of the inlet velocity was chosen to be parabolic for subsequent com-

parisons with one-dimensional analysis simulations [18]. For a prescribed input ﬂow, we do not expect that

the pressure ﬁelds will be signiﬁcantly diﬀerent between time-varying parabolic and Womersley inlet bound-

ary conditions. Furthermore, while the focus of this paper is on the outlet boundary conditions, the method

described could be applied in a similar fashion for inlet boundary conditions to include, for example, a

lumped model of the heart.

We ﬁrst consider pulsatile ﬂow in a straight vessel with a prescribed ﬂow rate at the inlet mapped into a

parabolic velocity proﬁle and diﬀerent boundary conditions at the outlet, to speciﬁcally observe the inﬂu-

ence of the outlet boundary condition on the solution in the numerical domain. The inlet ﬂow wave is a

representative carotid ﬂow rate [38,44,45]. The nominal radius of 0.3 cm and the vessel length of 12.6 cm

(length to diameter ratio of 20) were chosen to correspond approximately to that of the human common

carotid artery. The solution was computed on a 45,849 element and 9878 node mesh with a time step of

0.002 s, for a total of ﬁve cardiac cycles. The pressure pulse in the carotid artery has been reported to be

approximately 70–80/110–120 mmHg for a healthy person [38,46]. The resistance value is the ratio of mean

pressure to mean ﬂow. The impedance is generated following OlufsenÕs approach described in the introduc-

tion: a fractal tree is generated starting from a vessel that matched the diameter of the outlet and diminished

in size with each successive generation of vessels until a ﬁxed terminal vessel size was attained. The length-

to-radius ratio of the tree is chosen so that the zero-frequency of the impedance matches the previous resis-

tance boundary condition. The mean outlet pressure of the previous simulations is chosen to impose the

constant pressure outlet boundary condition. Fig. 3 depicts the results obtained with constant pressure,

resistance and impedance outﬂow boundary conditions. Flow is displayed for reference, since the incom-

pressibility constraint forces the ﬂow to be instantaneously the same at the outlet as that prescribed at

the inlet. The constant pressure outlet boundary condition results in a pressure pulse that does not have

the correct amplitude or phase (pressure lags ﬂow in reality). Note that this is the most common outlet

boundary condition used for three-dimensional analyses of blood ﬂow. The resistance boundary condition

results in an unrealistically large pressure pulse, and forces pressure and ﬂow to be in phase at the outlet.

However, the resistance boundary condition is an improvement over the constant pressure outlet boundary

condition when studying wave propagation, and does not require any knowledge of the pressure or ﬂow

wave forms before the simulation. Finally, Fig. 3 depicts the results for the impedance boundary condition.

In this case, the pressure wave is propagated down the length of the vessel with little damping or dispersion.

In this case, pressure lags ﬂow and the pressure amplitude and wave form are similar to curves given by

Nichols and OÕRourke [38]. Therefore, in regards to pressure curves, we conclude that the impedance

boundary condition is the most realistic boundary condition examined.

To further illustrate the critical inﬂuence of boundary conditions, we performed numerical simulations in

an idealized model of an abdominal aorta bifurcation to the iliac arteries with a 75% area reduction stenosis

on one side, using realistic anatomic dimensions (see Fig. 4a) and inﬂow wave form for an abdominal aortic

bifurcation. The ﬁnite element mesh consists of 94,280 elements and 19,579 nodes. A pulsatile, parabolic

proﬁle was imposed at the inlet, and constant pressure (P = 90 mmHg) or equal impedance boundary con-

ditions (with a resistance of 24,000 dynÁsÁcm

À5

) at the two outlets. The simulation was run for 10 cardiac

cycles, with a CFL number of 1 in the stenosis and thus a time step size of 0.0008 s, with three non-linear

3786 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

Fig. 3. Comparison of ﬂow and pressure wave forms in a carotid artery with a periodic inlet ﬂow and constant pressure, resistance and

impedance outlet boundary conditions. For the pressure boundary condition, inlet pressure varies little from the prescribed constant

outlet pressure and the peak pressure precedes the peak ﬂow. The resistance boundary condition gives rise to an unrealistically large

pressure amplitude. In addition, pressure and ﬂow are in phase at the outlet. For the impedance boundary condition, the range of

pressure is from approximately 85–115 mmHg and the pressure lags ﬂow along the length of the vessel. 1 mmHg = 133.3 Pa,

1 cc/s = 10

À6

m

3

/s.

Fig. 4. (a) Geometric model and (b) ﬂow distribution between normal iliac artery and an iliac artery with a stenosis that reduces the

cross-sectional area by 75% for constant pressure and impedance boundary conditions. For a constant outlet pressure, the ﬂow split is

dictated solely by the resistance to ﬂow due to the geometry of the computational domain (approximately 70% to the normal side, 30%

to the stenosed side). For an impedance boundary condition with a physiologic level of resistance, the ﬂow split (50%/50%) is

principally determined by the downstream demands (represented by equal outlet impedances). These results are consistent with clinical

observations for resting ﬂow conditions and iliac artery stenoses with less than an 85% area reduction.

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3787

iterations per time step. Fig. 4b depicts the dramatic diﬀerences in ﬂow split depending on outlet boundary

conditions. With a constant outlet pressure, the ﬂow split is dictated solely by the resistance to ﬂow due to

the geometry of the computational domain (70% ﬂow to the normal side, 30% to the stenosed side). With an

impedance boundary condition, the ﬂow split (50%/50%) is primarily determined by the downstream con-

ditions (represented by equal outlet impedances), which is representative of most clinical cases (i.e. for ste-

noses with less than an 85% area reduction). Note that because the impedance boundary condition

incorporates the history of ﬂow and pressure over a cardiac cycle, it takes longer for the solution to become

periodic (about 6 cycles) than that observed with a constant outlet pressure (within 2 cycles).

The time varying ﬂow and pressure curves at the inlet and outlets for the constant pressure and imped-

ance boundary conditions are shown in Fig. 5. With the constant pressure boundary condition, blood ﬂow

Fig. 5. Inlet and outlet ﬂow and pressure curves during the last two cardiac cycles of the simulation for constant pressure (90 mmHg)

and impedance outlet boundary conditions. Note that for the constant pressure boundary condition, the ﬂow to the normal iliac artery

exceeds that through the stenosed iliac artery for all time points in the cardiac cycle and the inlet pressure varies from approximately

88–96 mmHg. For the impedance outlet boundary condition, the peak ﬂow is greater in the normal iliac artery than the stenosed iliac

artery, yet during late systole and early diastole, the ﬂow is greater in the stenosed iliac artery than the normal iliac artery. Note that for

the impedance outlet boundary condition, the peak pressure for the normal iliac artery is close to that of the inlet pressure, whereas the

peak pressure for the stenosed iliac artery is signiﬁcantly less than that in the normal iliac artery. Also note that the inlet pressure varies

between approximately 88 and 106 mmHg. 1 mmHg = 133.3 Pa, 1 cc/s = 10

À6

m

3

/s.

3788 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

from the aorta to the normal iliac artery is greater than that to the stenosed iliac artery throughout the car-

diac cycle, following the 70/30 mean ﬂow split noted above. The inlet pressure amplitude for the pressure

boundary condition is not representative of physiologic conditions: it is solely determined by the instanta-

neous pressure gradient from the inlet to the prescribed constant outlets that is needed to drive the ﬂow to

both outlets, and therefore is only a slight variation from the mean value. For the impedance boundary

condition we observe that while the mean ﬂow split is nearly 50/50, the normal iliac artery gets more ﬂow

at peak systole (when the eﬀect of the 75% area stenosis is greatest) and less ﬂow during diastole. We also

note that for a brief period in diastole, the ﬂow in the stenosed iliac artery is actually greater than the inlet

ﬂow, indicating ﬂow is actually drawn from the normal iliac artery—coinciding with the brief period of re-

verse ﬂow in the normal iliac artery. This latter observation is quite interesting and perhaps due to the fact

that during the deceleration phase in late systole, blood is more easily decelerated in the normal iliac artery

than would be expected for the stenosed iliac artery. Again, note that this phenomenon is not observed

with constant outlet pressure boundary conditions. For the impedance boundary conditions, the inlet, nor-

mal iliac and right iliac pressure wave forms exhibit physiologic amplitudes and phase. Note that the peak

systolic pressure at the outlet of the stenosed iliac artery is considerably less than that observed in the nor-

mal iliac artery and that all the pressure waveforms exhibit little diﬀerence in diastole when the ﬂow rate is

low.

Fig. 6 provides a dramatic illustration of the diﬀerences in the velocity ﬁelds between the constant pres-

sure and impedance outlet boundary conditions. Velocity magnitude at peak systole and early diastole is

shown along the symmetry plane of the model. The velocity ﬁelds for the two diﬀerent outlet boundary con-

ditions exhibit substantial diﬀerences. We note, in particular, that the peak velocity through the stenosis is

much higher for the simulation performed with the impedance outlet boundary condition as compared to

that performed with the constant pressure outlet boundary condition. This is consistent with the signiﬁcant

diﬀerences in ﬂow through the stenosed iliac artery for the two boundary condition cases examined. Fig. 7

depicts the instantaneous pressure ﬁelds for the constant pressure and impedance outlet boundary condi-

tions at peak systole and early diastole. Note the fact that the scales are diﬀerent for the two boundary con-

ditions and the two time points in the cardiac cycle examined.

Finally, we consider pulsatile ﬂow in a model of the abdominal aorta of a normal subject with geome-

try and ﬂow rates generated from magnetic resonance imaging data [47]. The measured volumetric ﬂow rate

at the level of the diaphragm was speciﬁed at the inlet boundary and impedances are speciﬁed at all the

outlets. The exit impedances were chosen so that the mean ﬂow rate in each of the branches corresponded

to the measured ﬂow distribution when such data was available and literature data as needed [48,49]. Fig. 8

shows the 3D model. A total of 800,151 elements and 167,850 nodes were utilized and the solution was

computed using a time step of 0.001 s for a total of ﬁve cardiac cycles. Fig. 8 depicts the volume ﬂow rate

and pressure at the inlet and representative outlets of the subject-speciﬁc abdominal aorta model when

impedance boundary conditions are applied. Blood ﬂows into the diﬀerent arteries according to the pre-

scribed impedances representing the demands of the downstream trees. Previous simulations of pulsatile

ﬂow in the human abdominal aorta [50] were performed by imposing outﬂow velocity proﬁles using

WomersleyÕs theory of pulsatile ﬂow in rigid vessels to match the prescribed volumetric ﬂow rates. For

the branch vessels feeding the viscera (celiac, superior mesenteric, inferior mesenteric and renal arteries),

these ﬂow rates were scaled to some fraction of the inlet ﬂow waveform and reverse ﬂow in the iliac arter-

ies during diastole arose because more ﬂow was pulled from the other branch vessels than was input to

the abdominal aorta. Note that for the present simulations the ﬂow split between the branch vessels

occurs naturally. Finally, to illustrate the results that can be obtained from coupling three-dimensional sim-

ulations of blood ﬂow to impedance boundary conditions, the mean wall shear stress for the subject-speciﬁc

model is presented in Fig. 9. Clearly, mean wall shear stress will be highly aﬀected by the outlet boundary

conditions.

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3789

Fig. 6. Velocity magnitude along the symmetry plane of the model at peak systole and early-diastole for the constant pressure and

impedance outlet boundary conditions.

3790 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

Fig. 7. Pressure at peak systole and early diastole for the constant pressure and impedance outlet boundary conditions.

1 mmHg = 133.3 Pa.

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3791

Fig. 8. Pressure and ﬂow wave forms in a subject-speciﬁc model of the human abdominal aorta with a measured periodic inlet ﬂow rate

and impedance outlet boundary conditions. 1 mmHg = 133.3 Pa, 1 cc/s = 10

À6

m

3

/s.

3792 I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796

4. Conclusions

We have successfully developed and implemented a method to prescribe outﬂow boundary conditions

intended for three-dimensional ﬁnite element simulations of blood ﬂow based on the Dirichlet-to-Neumann

and variational multiscale methods. As long as the eﬀect of the downstream domain can be represented by

an explicit function of pressure as a function of ﬂow rate or velocity, the methods described can be used to

couple the upstream three-dimensional numerical domain with the downstream analytic domain. The

numerical results presented demonstrate that physiologic values of pressure can be attained and illustrate

the importance of using appropriate boundary conditions. A long straight cylindrical blood vessel is used to

demonstrate that realistic blood pressures can be calculated using this new method and that the choice of

the outlet boundary conditions has a signiﬁcant eﬀect on the computed pressure ﬁeld. The next example, an

otherwise symmetric model of an abdominal aortic bifurcation with an obstruction in one iliac, demon-

strates that the choice of outlet boundary conditions can dramatically aﬀect the ﬂow distribution, velocity

and pressure ﬁelds. The ﬁnal example, a patient speciﬁc abdominal aorta model, demonstrates that this ap-

proach can be used for complex multi-branched systems.

Results have been shown for idealized and patient speciﬁc 3D geometries, using physiological values,

coupled to more sophisticated downstream models that incorporate memory-eﬀects like the impedance

boundary condition. Lumped parameter models more complex than a simple resistance could be easily

incorporated in a manner similar to that used for the impedance boundary condition.

Fig. 9. Mean wall shear stress over one cardiac cycle for the subject-speciﬁc abdominal aorta model depicted in Fig. 8.

1 dyn/cm

2

= 0.1 Pa.

I.E. Vignon-Clementel et al. / Comput. Methods Appl. Mech. Engrg. 195 (2006) 3776–3796 3793

The stability of the solutions proved to be sensitive to the number of frequencies used to generate the

impedance boundary condition, due to the convolution with the ﬂow rate history. Although these results

are very encouraging, for a more realistic representation of ﬂow and pressure further analysis of the gen-

eration and validation of the impedance functions is needed. The impedance functions were generated using

a binary fractal tree that did not incorporate diﬀerences between the branching patterns in diﬀerent organs.

Alternate models based on physical measurements of branching patterns would aid in the speciﬁcation of

realistic impedance functions. A further limitation of the impedance boundary condition is that it is derived

based on the assumption of periodicity. An alternate outﬂow boundary condition that incorporates tran-

sient, non-periodic ﬂows or a coupling to the non-linear one-dimensional equations of blood ﬂow may be

needed for non-periodic three-dimensional ﬂow problems.

It is important to note that the present implementation does not incorporate deformable vessels in the

three-dimensional domain and, as such, does not model wave propagation from the three-dimensional to

one-dimensional domains. However, the analyses performed clearly indicate the need for appropriate

boundary conditions in computing pulse pressures. Realistic values of blood pressure (mean and pulse) will

be essential for obtaining accurate loading and displacement in ﬂuid-solid interaction methods. Finally, the

method described may be extensible to other biological and non-biological ﬂow phenomena where the

downstream model can be described as a function that links the primary variables or their derived quan-

tities at the coupling interface.

Acknowledgements

This material is based upon work supported by the National Science Foundation under Grant No.

0205741 and a predoctoral fellowship from the American Heart Association. The authors gratefully

acknowledge Dr. Mette Olufsen for the use of her methods to compute input impedance of vascular trees

and Dr. Farzin Shakib for his linear algebra package (http://www.acusim.com). Finally, the authors grate-

fully acknowledge the assistance of Dr. Nathan Wilson for assistance with software development, Dr. Mary

Draney for acquiring the subject-speciﬁc abdominal aorta MRI data, and Hyun Jin Kim for constructing

the abdominal aorta model.

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3777

Flow rate and pressure distributions are shown for diﬀerent boundary conditions to illustrate the dramatic inﬂuence of alternative boundary conditions on these quantities. Ó 2005 Elsevier B.V. All rights reserved.

Keywords: Blood ﬂow; Pressure; Boundary conditions; Coupled multidomain method; Finite elements

1. Introduction In normal and disease states in children and adults, quantiﬁcation of three-dimensional ﬂow phenomena and pressure ﬁelds is important to understand the response of the cardiovascular system to biomechanical forces [1]. In the development of the circulatory system in normal subjects and congenital heart disease patients, ﬂow modulates diameter and pressure controls wall thickness [2,3]. In older subjects, the initiation and progression of atherosclerotic and aneurismal disease is directly aﬀected by the complex three-dimensional ﬂuid mechanical environment of the major arteries [4,5]. Moreover, the ability to adequately simulate ﬂow and pressure is needed to model the performance of devices such as heart valves, LVADs (left ventricular assist devices), ﬁlters, stents and stent-grafts. Non-invasive three-dimensional ﬂow and pressure data can also provide important information to determine the signiﬁcance of an obstruction or predict the outcome of a procedure [6,7]. In recent years, remarkable progress has been made in simulating blood ﬂow in realistic anatomical models constructed from three-dimensional medical imaging data. Arguably, accurate anatomic models are of primary importance in simulating blood ﬂow. However, as we demonstrate in this paper, realistic boundary conditions are equally important in computing velocity and pressure ﬁelds. Yet, this subject has received far less attention than image-based model construction for three-dimensional simulations. In contrast, signiﬁcant progress has been made in devising outﬂow boundary conditions for solving the one-dimensional equations of blood ﬂow in elastic vessels. For example, Stergiopulos solved the non-linear one-dimensional equations of blood ﬂow in a comprehensive model of the arterial system using a lumped parameter model of the vasculature downstream of each branch in his numerical model [8]. Several groups have developed and analyzed the coupling of one-dimensional equations with lumped models [9–12]. In contrast to methods coupling the one-dimensional equations of blood ﬂow to lumped parameter models, Olufsen developed a distributed downstream model based on calculating the input impedance of an asymmetric binary fractal tree using WomersleyÕs linear wave theory [13,14] and an algorithm for computing the impedance of a vascular network ﬁrst proposed by Taylor [15]. OlufsenÕs approach was to generate a fractal tree for each outlet starting from a vessel that matched the diameter of the outlet and diminished in size with each successive generation of vessels until a ﬁxed terminal vessel size was attained. With this method an impedance for each outlet of the upstream numerical model was computed naturally from linear wave theory and branching laws. OlufsenÕs distributed model of the downstream vasculature enabled the representation of more realistic ﬂow and pressure waveforms than those obtained with lumped parameter models [16]. Steele and Taylor used a modiﬁed version of OlufsenÕs impedance boundary condition to model blood ﬂow at rest and during simulated exercise conditions [17]. In this case, vascular networks were assigned to the outlets of a model of the abdominal aorta, modiﬁed to represent the resting ﬂow distribution of 11 diﬀerent subjects and then dilated to simulate the eﬀects of lower limb exercise. Vignon and Taylor developed a multidomain approach to couple one-dimensional equations to diﬀerent lumped and onedimensional boundary conditions [18]. While these one-dimensional methods can be used to compute ﬂow rate and mean pressure, by design, they cannot be used to simulate complex three-dimensional ﬂow phenomena and pressure losses. Three-dimensional numerical methods have been used to compute velocity ﬁelds and quantify shear forces acting on the surface of blood vessels. However, since most three-dimensional models of blood ﬂow use zero or constant pressure, zero traction, or prescribed velocity proﬁles

A further limitation of these methods to couple three-dimensional and zero-dimensional models is the fact that there is no direct relationship between the anatomy of the downstream vascular bed and the lumped parameters resulting in diﬃculties in specifying these parameters and relating them to subsequent physiologic or pathophysiologic changes in the downstream vasculature. / Comput. While inadequate outﬂow boundary conditions and rigid-wall models are the main impediments to the realistic prediction of pressure in three-dimensional blood ﬂow simulations. Engrg. capillaries. in this paper we focus on the ﬁrst issue and do not address the issue of wall deformability in the three-dimensional domain. anatomic information is available for vessels downstream of the primary region of interest. The approach we describe is based on the Dirichlet-to-Neumann (DtN) [36] and the variational multiscale [37] methods and is an extension of the 1D coupled multidomain approach we successfully applied with a variety of models of the downstream domain [18].3778 I. We also noted that the . While great progress was made in these landmark papers. a simpler approach is to directly represent the vasculature of the small arteries and arterioles using zero-dimensional or one-dimensional models. but this coupling has been performed iteratively.E. The incorporation of such data would improve the accuracy of the models of the downstream vasculature. for many simulations based on three-dimensional imaging data.25–33] have successfully coupled threedimensional models to either resistances or more sophisticated zero-dimensional models (lumped models). Based on our experience. we demonstrated that a DtN map can be calculated for the impedance of complex vascular trees and that this approach incorporates naturally occurring wave reﬂections from a downstream bed. venules and veins returning blood to the heart. For one-dimensional problems. neglecting the dominant eﬀect of the resistance of the downstream vascular beds. We describe a new method to prescribe outﬂow boundary conditions in the context of the ﬁnite element method as this method is particularly well suited for handling complex geometries and boundary conditions inherent in modeling blood ﬂow [24]. However. These models can be terminated at the level of the capillary vessels where an assumption of constant pressure is reasonable. using linear wave propagation theory the input impedance of the downstream vascular bed can be computed for large complex vascular trees. For simulations of blood ﬂow in large arteries. Mech. While closed-loop models are optimal. If zero or equal pressures or tractions are used for diﬀerent outlets. especially for models with multiple outlets. the ﬂow split will be dictated solely by the resistance to ﬂow in the branches of the domain of interest. non-linear one-dimensional models would be intractable. these papers did not include coupling between three-dimensional domains and complex vascular networks as have been incorporated in onedimensional numerical solutions of blood ﬂow in arteries. the outlet boundary conditions represent the downstream vasculature including smaller arteries. blood pressure is not computed accurately and notably absent from reports of hemodynamic investigations [19–24]. Clearly. yet ignoring the eﬀect of the downstream circulation results in grossly inaccurate predictions of velocity and pressure ﬁelds for many problems where the distribution of ﬂow between the major arteries is unknown. In addition. implicit coupling signiﬁcantly improves convergence. the vast extent and complexity of the circulation precludes a three-dimensional representation of the entire circuit. Methods to couple three-dimensional and one-dimensional models were ﬁrst described by Formaggia et al. and reducedorder models to represent the remainder of the system. [34. Vignon-Clementel et al. Since the vascular bed from the major arteries to the capillaries can include tens of millions of blood vessels. Several groups [6. Wave propagation in transient and periodic states was simulated and the importance of selecting appropriate boundary conditions was demonstrated for one-dimensional simulations of blood ﬂow. the coupling was performed for simple geometries and iteratively. and generally applied to geometries with few outlets and low resistances (as seen in the pulmonary vasculature). 195 (2006) 3776–3796 as outlet boundary conditions. Methods Appl. An alternative approach is to utilize three-dimensional models for the major arteries where high-ﬁdelity information is needed. arterioles. In addition.35]. A method to prescribe the impedance (calculated using linear wave theory) of these downstream vascular beds at the outlets of three-dimensional models would enable the speciﬁcation of realistic boundary conditions for three-dimensional simulations of blood ﬂow and pressure.

and was successfully implemented in both cases. Given the computational expense of three-dimensional numerical methods and the resolution limits imposed by current imaging technologies. The organization of the paper will begin with the description of our coupled multidomain method in three-dimensions and its specialization to resistance and impedance boundary conditions. a bifurcation model with a stenosis on one side. where information from the downstream (analytical) domain is incorporated in the upstream (computational) domain through a boundary map. and variations in wall properties) should propagate back upstream into the numerical domain. We proceed by deﬁning the spatial domain as X and its boundary as C. We concluded that. at present. and a subject-speciﬁc model of the human abdominal aorta. 1). tapering. 1. This approach accommodates a variety of downstream models ranging from pure resistive to complex electrical analogs and impedance models. best boundary condition for cardiovascular applications is not the one that exhibits no wave reﬂection.1. Engrg. Methods 2. Methods Appl. 195 (2006) 3776–3796 3779 Fig. Vignon-Clementel et al. cylindrical blood vessel.I. The outlet boundary conditions are implemented implicitly resulting in good stability and convergence properties at physiologic pressures. and model the downstream domains with simpler models (Fig. Governing equations (strong form) The method described can be applied to conservative as well as advective formulations of the incompressible Navier–Stokes equations. 2. Illustration of the ‘‘Coupled Multidomain Method’’. In this paper we present a coupled multidomain approach for three-dimensional ﬁnite element simulations of blood ﬂow and pressure. / Comput. since wave reﬂections naturally arising from downstream beds (from bifurcations. we constrain the three-dimensional domain to the major arteries. The three-dimensional equations for the ﬂow of an incompressible Newtonian ﬂuid consist of the three momentum balance equations and the continuity equation (written here in advective form) subject to suitable initial and boundary conditions .E. We then demonstrate this new method on a straight. Mech. impedance-based boundary conditions are the best approach for incorporating natural sites of wave reﬂection in the downstream vasculature.

Methods Appl. vz Þ and the pressure p. The density of the ﬂuid is giv ven by q (assumed constant).t þ q~ Á r~ ¼ Àrp þ divðs Þ þ ~ v v v f $ divð~ ¼ 0 vÞ $ ð1Þ 1 v v with D ¼ ðr~ þ r~T Þ. First. x vð~ v x. tÞ ¼ ~in ð~ tÞ ~ 2 Cin & Cg . w v. Weak form We deﬁne the trial solution and weighting function spaces for the semi-discrete formulation as S ¼ f~ vðÁ. tÞ 2 H ðXÞ. t 2 ½0. g nsd 1 W ¼ f~j~ðÁ. ð~ tÞ 2 X Â ½0. Engrg. Considering this.3. The initial conditions for this problem are given by ~ x.3780 I.~ pÞ ¼ 0. vð~ v xÞ x 2. and a downstream ‘‘analytic’’ do0 0 b b main X 0 such that X \ X ¼ . The boundary that separates these domains is deﬁned as CB (Fig. vy . 0Þ ¼ ~0 ð~ ~ 2 X.~ tÞ ¼ ~ on Cg g.~ pÞ ¼ w v. / Comput.2.t þ q~ Á r~ À ~Þ þ r~ : ðÀp I þ sÞ d~ BG ð~. the velocity at the inlet(s) of the domain is typically speciﬁed as ~ x. T . Mech. $ 2 s ¼ 2l D $ The primary variables are the ﬂuid velocity ~ ¼ ðvx . Vignon-Clementel et al. we b divide the spatial domain X into an upstream ‘‘numerical’’ domain X. vj~ vðÁ. and X [ X ¼ X. x. Cg \ Ch = . q. ww w 0 P ¼ fpjpðÁ. f In regards to boundary conditions. The weak form reads: ﬁnd ~ 2 S and p 2 P such that for every ~ 2 W and q 2 P v w BG ð~. where H1 represents the usual Sobolev space of functions with square-integrable values and ﬁrst derivatives in X. tÞ 2 H ðXÞ . We discuss outﬂow boundary conditions subsequently. the external force by ~. b U ¼ U þ U0 b with U jX0 ¼ 0 and U 0 jX ¼ 0 ^ ð6Þ .E. T . T g.37]. Uð~ tÞ ¼ ½~ p . ~ðÁ. v. q. x. 195 (2006) 3776–3796 q~. ð2Þ A no-slip boundary condition is imposed on the walls (surfaces that are neither inlets nor outlets). T . We deﬁne a disjoint decomposition of the variables. À rq Á~d~ À v x n v n w X Ch $ $ C 1 n ð3Þ ð4Þ ð5Þ 2. t 2 ½0. and the viscosity by l (assumed constant). nsd represents the number of spatial dimensions and ~ represents the prescribed Dirichlet boundary g condition. for example for the unknown solution T vector.). 2). the boundary C of the spatial domain can be split into a Dirichlet partition Cg and a Neumann partition Ch such that (C = oX = Cg [ Ch. tÞ ¼ ~ on Cg g. v v f w x w v $ $ X Z Z Z ~ Á ðÀp I þ sÞ Á ~ds þ q~ Á ~ds. Z n o ~ Á ðq~. tÞ 2 H 1 ðXÞ sd . t 2 ½0. Coupled multidomain method We adopt the following approach to derive appropriate outﬂow boundary conditions [18.

Methods Appl. / Comput. since U vanishes on X 0 and U 0 vanishes on X (and similarly for the weighting functions).I. C The disjoint nature of this expression is used to derive a new variational form for the numerical domain. separated by the coupling boundary CB ¼ [i CBi (here in green). 195 (2006) 3776–3796 3781 b Fig.E. b b Speciﬁcally.t Þ þ qð~ þ~0 Þ Á rð~ þ~0 Þ À ~ þ ðr~ þ r~0 Þ : Àð^ þ p0 Þ I þð^ þ s0 Þ d~ w w v v v v v f w w p s x $ X Z Z ^ ^ À ð~ þ ~0 Þ Á Àð^ þ p0 Þ I þð^ þ s0 Þ Á ~ds À ðr^ þ rq0 Þ Á ð~ þ~0 Þ d~ w w p s n q v v x $ $ $ Ch X Z ^ q v v n ð9Þ þ ð^ þ q0 Þð~ þ~0 Þ Á ~ds ¼ 0. Engrg. Vignon-Clementel et al. 2.t þ~0. ð8Þ We use a similar decomposition for the weighting functions. we ﬁnd: . so that n b x b U ¼ U j~ 2 X. The spatial domain is divided between the upstream numerical domain X (main model) and the downstream analytic domain b X ¼ [i X0i (here the trees). and insert these expressions into the previous variational form: Z ^ v ^ ^ ^ ^ ð~ þ ~0 Þ Á qð~. Mech. x ð7Þ Note also that ^ ~0 ¼ À~ n n. U 0 j~ 2 X0 x and o b U ¼ U 0 ~ 2 CB .

H c CB are deﬁned on the X 0 domain based on the chosen mod$ $ el to represent the downstream domain (diﬀerent examples are provided subsequently). v $ $ $ $ ~ jCB v 0 ~ v ~ % ½M c ð~0 . Mech. p0 Þ þ H m CB . p0 Þ þ H c CB . Methods Appl. we obtain the original variational form specialized to the numerical domain X 0 with the addition of boundary terms accounting for the interface to the analytic domain. Then using Eqs. q ~ v. p CB The resulting weak form for the multidomain method is then Z Z ^ ^ v f ^ ^ ^ ^ ^ ~ Á ðq~. p n w Z CB 0 0 0 $ $ q ~ Á ~ ds % À v n Z CB CB $ $ ð14Þ ^ ^ ~ n ^ðM c ð~ ^Þ þ H c Þ Á ~ds. p0 Þ þ H c Þ Á ~0 ds. p Z CB CB $ $ ð13Þ ~ v ~ q0 ðM c ð~0 .t þ q~ Á r~ À ~Þ þ r~ : ðÀ^ I þ^Þ d~ À ^ ^ ^ ~ ~ Á ðÀ^ I þ^Þ Á ~ds w v w p v w p s x s n ^ X $ $ þ Z CB ~0 Á ðÀp0 I þs0 Þ Á ~0 ds À n w $ $ Z ^ X ^ r^ Á ~d~ þ q v x Z ^ C ^ Ch $ $ ^ ^ ^~ Á ~ds À qv n Z CB q0~0 Á ~0 ds ¼ 0. ð12Þ ~ ~ The operators M ¼ ½M m . M c CB and H ¼ ½H m .E. p0 Þ þ H m Þ Á ~0 ds. ~0 and p 0 in the downstream domain.t þ q~0 Á r~0 À ~Þ þ r~0 : ðÀp0 I þs 0 Þ d~ À ~0 Á ðÀp0 I þs 0 Þ Á ~0 ds À r^ Á ~d~ v v v f w x n q v x w w þ $ $ $ $ ^ X0 C0 X h Z Z Z ^ ^ rq0 Á~0 d~ þ v x q0~0 Á n0 ds ¼ 0. Engrg. v . n v n w Z CB $ $ ^ ^ ~ n ^ðM c ð~ ^Þ þ H c Þ Á ~ds ¼ À q ~ v. v n ð11Þ Here we introduce an approximation to be able to quantify the terms above that come from the downstream domain: ðÀp0 I þ s0 ÞjCB % ½M m ð~0 . w v w p v w p s x s n ^ X $ $ À Z CB ^ ^ ^ ~ Á ðM m ð~ ^Þ þ H m Þ Á ~ds À w v. q ~ v.t þ q~ Á r~ À ~Þ þ r~ : ðÀ^ I þ^Þ d~ À ^ ^ ^ ~ ~ Á ðÀ^ I þ^Þ Á ~ds w v w p v w p s x s n $ $ $ $ ^ ^ Ch X Z Z Z ^ ~0 Á ðq~0. p n $ $ Z ^ X ^ Ch $ $ ^ r^ Á ~d~ þ q v x Z ^ ^ ^~ Á ~ds þ qv n ^ C Z CB ^ ^ ~ n ^ðM c ð~ ^Þ þ H c Þ Á ~ds ¼ 0. w v. X Z Z ^ ^ v f ^ ^ Á ðq~. we enforce the continuity of the momentum and mass ﬂuxes across CB Z Z ^p ^ Á ðM m ð~ ^Þ þ H m Þ Á ~ds ¼ À ^ ~ ~0 Á ðM m ð~0 . p ð15Þ We see that the solution in the numerical domain depends on operators deﬁned by the mathematical model chosen to represent the physics of the downstream domain (see the terms in boxes) but not the solution variable. (7) and (8).3782 I. 195 (2006) 3776–3796 Z Z ^ ^ v f ^ ^ Á ðq~. ð10Þ qv n v ~ þ ^~ Á ~ds À ^ C X0 C0 b Now since (1) holds in X 0 . n CB We thus approximate the boundary terms on CB in the weak form (11) by Z Z ^ ^ ^ ~ Á ðM m ð~ ^Þ þ H m Þ Á ~ds. Vignon-Clementel et al.t þ q~ Á r~ À ~Þ þ r~ : ðÀ^ I þ^Þ d~ À ~ Á ðÀ^ I þ^Þ Á ~ds. / Comput. ~0 Á ðÀp0 I þs0 Þ Á ~0 ds % À w n v.

4.E. we have the goal of obtaining a representation formula whereby the solution on the boundary CB can be obtained as a function of the problem on the interior of the analytic domain and the outlet(s) of the analytic domain. full traction relationships instead of just the normal component. w w w s n v n v. the resistance. we will have a relationship between mean pressure and ﬂow rate at CB. Derivation of the operators depending on the model chosen to represent the physics in the downstream domain In selecting a mathematical model of the downstream domain X 0 . The general concept of resistance is to deﬁne a constant relationship between mean pressure and ﬂow rate P = QR [38].I. namely zero-dimensional models and one-dimensional wave propagation theory. We consider two possibilities.4. n ð18Þ CB CB $ $ CB CB $ CB $ Therefore. the operators M and H are deﬁned as Z . Vignon-Clementel et al. v n CB ð16Þ ð17Þ CB ~ c ð~0 . p0 Þ þ H c ¼ ~0 jC . 195 (2006) 3776–3796 3783 2. this representation formula will depend on the approximations we introduce in treating the downstream domain. Methods Appl. 2. We make the assumption that pressure in the downstream domain is constant over the cross-sectional area of the inlet boundary CB so that Z p0 ds ds CB n n p À~ Á s Á~ ¼ p À 0 ¼ Z $ 0 0 0 0 0 CB ¼ ÀR Z ~0 Á ~0 ds. CB b is an inlet for X 0 and an outlet for X. / Comput. but this method can incorporate more general relationships between the primary variables or functions of them—namely. consistent with Poiseuille ﬂow where the ﬂow is fully developed (gradients in the axial direction are zero). ~ ½M v v B CB Note that the sign of the resistance part of the operators changes if the face is an inlet or an outlet. Fundamentally. the ﬁrst box representing a term on the coupling interface CB in (15) is modiﬁed as follows: Z Z Z Z ^ Á ~ds þ ~ Á ^ Á ~ ds þ ^p ^ Á ðM m ð~ ^Þ þ H m Þ Á ~ds ¼ À ^ Á~ R ^ ^ ^ ^ s n ^ ^ ^ ~ n ~ ~ n ~ Á ^ Á ~ds. Here. In this simple resistance case. Mech.1. Engrg. In those cases. Resistance boundary condition We ﬁrst present the results for the simplest zero-dimensional model for the downstream domain.

.

0 0 0 0 0 0 0 0 ~ Á ~ ds I þs À ~ Á s Á ~ I .

p Þ þ H m CB ¼ R v n . v n n ½M m ð~ . .

Note that in this theory ~ Á s Á~ is negligible. In this paper the downstream domain is approximated using WomersleyÕs linear wave theory [13. ¼À Zðt À t1 Þ n ð19Þ v T tÀT CB The ﬂow rate at time t depends on the history of the pressure over one period. which is analogous to the concept of impedance in electricity. Impedance boundary condition An example of a memory map is the impedance model.14] in an asymmetric fractal tree to derive a one-dimensional impedance Z(t) assuming periodicity in time. $ $ $ $ $ $ 2.4.2. We can then derive for an inlet face: n n Z $ p0 ds Z 1 t CB 0 0 0 0 0 p À~ Á s Á~ % p À 0 ¼ Z n n Zðt À t1 Þq0 ðt1 Þ dt1 ¼À $ T tÀT ds CB Z Z 1 t ~0 ðt1 Þ Á ~0 ds dt1 . The representation formula for the operators is obtained as .

Engrg.3784 0 0 I. Methods Appl.E. p Þ þ H m CB v $ $ 0 0 Z t . Mech. Vignon-Clementel et al. 195 (2006) 3776–3796 ½M m ð~ . / Comput.

Z .

1 0 0 0 0 0 0 ~ ðt1 Þ Á ~ ds dt1 I þs À ~ Á s Á ~ I .

. ¼ Zðt À t1 Þ n n n v $ $ $ $ .

the ﬁrst box on the coupling interface CB in (15) is modiﬁed as follows: Z t Z Z Z ^ ^ ^ ^ ^ 1 ^ ^ ^ ^ ~ 1 Þ Á ~ds dt1 þ ~ Á ^ Á ~ ds ~ Á ðM m ð~ ^Þ þ H m Þ Á ~ds ¼ À ~ Á~ w w n vðt v. t 2 ½0. the magnitude of the tangential tractions which arise in Eqs.5. (18) and (21) are very small relative to other terms and could be neglected with minimal eﬀect on accuracy and stability. we omit the ^ superscript from the ﬁeld variables and the corresponding spaces in the subsequent sections. w s n w nðn s nÞ ð22Þ CB $ $ These so-called ‘‘consistent boundary conditions’’ are not in fact boundary conditions since they are directly computed from the solution variables. Remark 2. In particular. þ w s n ð21Þ CB $ Remark 1. Remark 4. T tÀT CB CB 0 ð20Þ ~ v ~ ½M c ð~ . tÞ ¼ ~ on Cg g. Thus this method enforces an implicitly coupled boundary condition. ~jx2Xe 2 P k ðXe Þ sd . tÞ 2 H 1 ðXÞ sd . The components of the natural boundary integrals over Ch in (5) that are not explicitly described above in (18) and (21) are computed directly from the current solution Z ^ ^ ^ ^^ ^ ~ Á ^ Á ~ À ~ Á ~ ~ Á ^ Á ~ ds. The discrete trial solution and weighting function spaces for the semi-discrete formulation are given by ^ Sk ¼ f~ vðÁ. t 2 ½0. t 2 ½0. p n Zðt À t1 Þ n n s n $ $ $ T tÀT CB CB CB Z ^ ^ ~ Á ^ Á ~ds.~ ~ e 2 P k ðXe Þ sd . pjx2Xe 2 P k ðXe Þg. Finite element discretization We employ a stabilized semi-discrete ﬁnite element method. The method described above can also be used when the impedance is derived from a (zerodimensional) lumped parameter model. tÞ 2 H 1 ðXÞ. tÞ 2 H 1 ðXÞ sd . Franca and Frey [41]. h w Considering this. T .~ tÞ ¼ ~ on Cg g. v As before. [24]. ww w w 0 h ð23Þ Pk ¼ fpjpðÁ. For this memory case. Pressure and velocities on the boundary become unknown solution variables. g h n n n n W k ¼ f~j~ðÁ. For simplicity. vj~ vjx2X vðÁ. Remark 3. T . 2. T . For a description of this as well as many alternative outﬂow boundary conditions see Gresho and Sani [39]. p Þ þ H c CB ¼ ~ jCB . Taylor et al. CB is an inlet for X 0 and an outlet for X. note that the sign of the impedance part of the operators changes if the face is an inlet or an ^ outlet. ~ðÁ. the weak form becomes: ﬁnd ~ 2 Sk and p 2 Pk such that for every ~ 2 Wk and m h h h q 2 Pk h . based on ideas developed in Brooks and Hughes [40]. Here.

Vignon-Clementel et al. Lð~ pÞ represents the residual vector of the momentum equation: ~ v. Methods Appl.I. In this equation. vÞg x rq Á sM ~ Lð~ pÞ d~ v. ~ n qðM c ð~ pÞ þ H c Þ Á ~dC .t þ q~ Á r~ þ rp À r Á s À~. x is the frequency of rotation of the reference frame. q Z Xe Xe ~ v.42]: Find ~ 2 Sk and p 2 Pk such that for every ~ 2 W k and q 2 Pk v w h h h h Bð~. and g is $ the covariant metric tensor nx nx g ¼ ð~. Bð~. we veriﬁed that the relationships .43].~. $ ð29Þ These non-linear equation (25) are then solved using methods described in [42. w v. q ð27Þ The stabilization parameters are deﬁned as follows: 1 sM ¼ rﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃ . Note that the boundary terms are identiﬁed in the box. C sC is a scale factor for sC. We observed good numerical convergence and stability properties. 195 (2006) 3776–3796 3785 BG ð~. w v. the formulation becomes [24.~ pÞ ¼ f~ Á ðq~. Z Z ~Þ þ r~ : ðÀp I þ s Þg d~ À rq Á~d~ BG ð~. $ D ð26Þ And ~ is a conservation-restoring advective velocity whose expression is given by v D ~¼ À v sM ~ Lð~ pÞ. Mech. The ‘‘coupled multidomain method’’ was implemented for diﬀerent boundary conditions in both the advective and the conservative forms. 2 v v ð2c1 =DtÞ þ~ Á g ~ þ c2 m2 ðg : g þx2 Þ $ $ $ sC ¼ q C sC 8sM trðgÞ c1 $ sM and ¼ rﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃﬃ . n w CB $ $ Z CB ~ v. / Comput.~ pÞ ¼ BG ð~. x.~ pÞ ¼ 0. explicitly (in the residual only) and implicitly (in both the tangent matrix and the residual). q. Lð~ pÞ Á g ÁLð~ pÞ $ ð28Þ where c1 and c2 are constants deﬁned from the one-dimensional scalar model problem of the advection–diffusion equation. f~ Á ðq~ Ár~ þ ðLð~ pÞ Á r~Þ Á ðLð~ pÞ Á r~ d~ w v vÞ w s ~ v. q.t þ q~ Á r~ À f w v. w v v v w x v x $ $ X X Z Z ~ðÀp I þ s Þ~ds þ À n q~ Á ~ds v n w À Z Ch $ $ CÀCB ð24Þ ~ðM m ð~ pÞ þ H m Þ Á ~dC þ v.E. In addition.~ pÞ þ w v. v. þ þ nel XZ e¼1 nel X e¼1 nel XZ e¼1 D Xe ~ v. Engrg. fð~ Á rÞ~ Á sM Lð~ pÞ þ r Á ~sC r Á~ d~ v w vg x w ð25Þ ~ v. ~ v. q.~ÞT~.~ pÞ ¼ 0. k of the discrete approximation of the continuous variables have been omitted for simplicity. q. w v. v v f v Lð~ pÞ ¼ q~. s ~ v. In order to stabilize the Galerkin method. the superscripts h. q.

195 (2006) 3776–3796 we imposed as boundary conditions were numerically satisﬁed and checked for mass conservation between the inlet and outlets. Furthermore. we do not expect that the pressure ﬁelds will be signiﬁcantly diﬀerent between time-varying parabolic and Womersley inlet boundary conditions.0008 s.45]. The resistance value is the ratio of mean pressure to mean ﬂow. using realistic anatomic dimensions (see Fig. 3.6 cm (length to diameter ratio of 20) were chosen to correspond approximately to that of the human common carotid artery. Subsequent to the veriﬁcation studies. The impedance is generated following OlufsenÕs approach described in the introduction: a fractal tree is generated starting from a vessel that matched the diameter of the outlet and diminished in size with each successive generation of vessels until a ﬁxed terminal vessel size was attained. 4a) and inﬂow wave form for an abdominal aortic bifurcation. and forces pressure and ﬂow to be in phase at the outlet. with three non-linear . Flow is displayed for reference. For a prescribed input ﬂow. to speciﬁcally observe the inﬂuence of the outlet boundary condition on the solution in the numerical domain. and constant pressure (P = 90 mmHg) or equal impedance boundary conditions (with a resistance of 24. The lengthto-radius ratio of the tree is chosen so that the zero-frequency of the impedance matches the previous resistance boundary condition. for example. for a total of ﬁve cardiac cycles. Results In the examples below.44.3 cm and the vessel length of 12.E. a lumped model of the heart. A pulsatile. we conclude that the impedance boundary condition is the most realistic boundary condition examined. the resistance boundary condition is an improvement over the constant pressure outlet boundary condition when studying wave propagation.579 nodes. / Comput.3786 I. while the focus of this paper is on the outlet boundary conditions. 3 depicts the results for the impedance boundary condition. Fig. To further illustrate the critical inﬂuence of boundary conditions. Finally. and does not require any knowledge of the pressure or ﬂow wave forms before the simulation. we performed numerical simulations in an idealized model of an abdominal aorta bifurcation to the iliac arteries with a 75% area reduction stenosis on one side. the method described could be applied in a similar fashion for inlet boundary conditions to include. The constant pressure outlet boundary condition results in a pressure pulse that does not have the correct amplitude or phase (pressure lags ﬂow in reality). resistance and constant pressure boundary conditions.002 s. This is described fully in the next section. The mean outlet pressure of the previous simulations is chosen to impose the constant pressure outlet boundary condition. the proﬁle of the inlet velocity was chosen to be parabolic for subsequent comparisons with one-dimensional analysis simulations [18]. Methods Appl. However. The resistance boundary condition results in an unrealistically large pressure pulse. in regards to pressure curves. since the incompressibility constraint forces the ﬂow to be instantaneously the same at the outlet as that prescribed at the inlet. The ﬁnite element mesh consists of 94. with a CFL number of 1 in the stenosis and thus a time step size of 0. We ﬁrst consider pulsatile ﬂow in a straight vessel with a prescribed ﬂow rate at the inlet mapped into a parabolic velocity proﬁle and diﬀerent boundary conditions at the outlet. The solution was computed on a 45. Vignon-Clementel et al. Mech.280 elements and 19. The pressure pulse in the carotid artery has been reported to be approximately 70–80/110–120 mmHg for a healthy person [38. pressure lags ﬂow and the pressure amplitude and wave form are similar to curves given by Nichols and OÕRourke [38]. parabolic proﬁle was imposed at the inlet. 3 depicts the results obtained with constant pressure.000 dynÁsÁcmÀ5) at the two outlets. we solved a series of problems to demonstrate that realistic pressure ﬁelds could be computed and to compare and contrast impedance. In this case. Engrg. Therefore. The inlet ﬂow wave is a representative carotid ﬂow rate [38. resistance and impedance outﬂow boundary conditions. The nominal radius of 0. the pressure wave is propagated down the length of the vessel with little damping or dispersion.849 element and 9878 node mesh with a time step of 0. Note that this is the most common outlet boundary condition used for three-dimensional analyses of blood ﬂow.46]. The simulation was run for 10 cardiac cycles. In this case. Fig.

3 Pa. Methods Appl. inlet pressure varies little from the prescribed constant outlet pressure and the peak pressure precedes the peak ﬂow. Vignon-Clementel et al. The resistance boundary condition gives rise to an unrealistically large pressure amplitude. . 4. 195 (2006) 3776–3796 3787 Fig. For the impedance boundary condition. Mech. For an impedance boundary condition with a physiologic level of resistance. 3. These results are consistent with clinical observations for resting ﬂow conditions and iliac artery stenoses with less than an 85% area reduction. pressure and ﬂow are in phase at the outlet. Engrg. Comparison of ﬂow and pressure wave forms in a carotid artery with a periodic inlet ﬂow and constant pressure.I. the ﬂow split is dictated solely by the resistance to ﬂow due to the geometry of the computational domain (approximately 70% to the normal side. Fig. / Comput. 1 cc/s = 10À6 m3/s. the range of pressure is from approximately 85–115 mmHg and the pressure lags ﬂow along the length of the vessel. For a constant outlet pressure.E. (a) Geometric model and (b) ﬂow distribution between normal iliac artery and an iliac artery with a stenosis that reduces the cross-sectional area by 75% for constant pressure and impedance boundary conditions. 30% to the stenosed side). For the pressure boundary condition. resistance and impedance outlet boundary conditions. the ﬂow split (50%/50%) is principally determined by the downstream demands (represented by equal outlet impedances). 1 mmHg = 133. In addition.

the ﬂow to the normal iliac artery exceeds that through the stenosed iliac artery for all time points in the cardiac cycle and the inlet pressure varies from approximately 88–96 mmHg. Methods Appl. 30% to the stenosed side). With the constant pressure boundary condition. the ﬂow split is dictated solely by the resistance to ﬂow due to the geometry of the computational domain (70% ﬂow to the normal side. Also note that the inlet pressure varies between approximately 88 and 106 mmHg. With an impedance boundary condition. Note that for the constant pressure boundary condition. whereas the peak pressure for the stenosed iliac artery is signiﬁcantly less than that in the normal iliac artery. Mech.3788 I. the peak pressure for the normal iliac artery is close to that of the inlet pressure. the ﬂow split (50%/50%) is primarily determined by the downstream conditions (represented by equal outlet impedances). Vignon-Clementel et al. Engrg. With a constant outlet pressure. The time varying ﬂow and pressure curves at the inlet and outlets for the constant pressure and impedance boundary conditions are shown in Fig. 5. / Comput.3 Pa.E. Inlet and outlet ﬂow and pressure curves during the last two cardiac cycles of the simulation for constant pressure (90 mmHg) and impedance outlet boundary conditions. 1 mmHg = 133.e. yet during late systole and early diastole. for stenoses with less than an 85% area reduction). Note that for the impedance outlet boundary condition. the peak ﬂow is greater in the normal iliac artery than the stenosed iliac artery. blood ﬂow Fig. which is representative of most clinical cases (i. 1 cc/s = 10À6 m3/s. 4b depicts the dramatic diﬀerences in ﬂow split depending on outlet boundary conditions. the ﬂow is greater in the stenosed iliac artery than the normal iliac artery. it takes longer for the solution to become periodic (about 6 cycles) than that observed with a constant outlet pressure (within 2 cycles). Fig. 5. 195 (2006) 3776–3796 iterations per time step. Note that because the impedance boundary condition incorporates the history of ﬂow and pressure over a cardiac cycle. For the impedance outlet boundary condition. .

Again. 9. these ﬂow rates were scaled to some fraction of the inlet ﬂow waveform and reverse ﬂow in the iliac arteries during diastole arose because more ﬂow was pulled from the other branch vessels than was input to the abdominal aorta. 6 provides a dramatic illustration of the diﬀerences in the velocity ﬁelds between the constant pressure and impedance outlet boundary conditions. / Comput. Finally. Vignon-Clementel et al. Note the fact that the scales are diﬀerent for the two boundary conditions and the two time points in the cardiac cycle examined. This is consistent with the signiﬁcant diﬀerences in ﬂow through the stenosed iliac artery for the two boundary condition cases examined. The measured volumetric ﬂow rate at the level of the diaphragm was speciﬁed at the inlet boundary and impedances are speciﬁed at all the outlets. indicating ﬂow is actually drawn from the normal iliac artery—coinciding with the brief period of reverse ﬂow in the normal iliac artery.E. note that this phenomenon is not observed with constant outlet pressure boundary conditions. mean wall shear stress will be highly aﬀected by the outlet boundary conditions. Blood ﬂows into the diﬀerent arteries according to the prescribed impedances representing the demands of the downstream trees.001 s for a total of ﬁve cardiac cycles. Fig. We note. the ﬂow in the stenosed iliac artery is actually greater than the inlet ﬂow. the normal iliac artery gets more ﬂow at peak systole (when the eﬀect of the 75% area stenosis is greatest) and less ﬂow during diastole. Previous simulations of pulsatile ﬂow in the human abdominal aorta [50] were performed by imposing outﬂow velocity proﬁles using WomersleyÕs theory of pulsatile ﬂow in rigid vessels to match the prescribed volumetric ﬂow rates. The exit impedances were chosen so that the mean ﬂow rate in each of the branches corresponded to the measured ﬂow distribution when such data was available and literature data as needed [48. Methods Appl. 7 depicts the instantaneous pressure ﬁelds for the constant pressure and impedance outlet boundary conditions at peak systole and early diastole. that the peak velocity through the stenosis is much higher for the simulation performed with the impedance outlet boundary condition as compared to that performed with the constant pressure outlet boundary condition. Clearly. We also note that for a brief period in diastole.850 nodes were utilized and the solution was computed using a time step of 0. the mean wall shear stress for the subject-speciﬁc model is presented in Fig. inferior mesenteric and renal arteries). Velocity magnitude at peak systole and early diastole is shown along the symmetry plane of the model. 8 depicts the volume ﬂow rate and pressure at the inlet and representative outlets of the subject-speciﬁc abdominal aorta model when impedance boundary conditions are applied. Fig. Fig. and therefore is only a slight variation from the mean value. Note that for the present simulations the ﬂow split between the branch vessels occurs naturally. Fig.151 elements and 167. A total of 800. to illustrate the results that can be obtained from coupling three-dimensional simulations of blood ﬂow to impedance boundary conditions. Note that the peak systolic pressure at the outlet of the stenosed iliac artery is considerably less than that observed in the normal iliac artery and that all the pressure waveforms exhibit little diﬀerence in diastole when the ﬂow rate is low. Finally. in particular. we consider pulsatile ﬂow in a model of the abdominal aorta of a normal subject with geometry and ﬂow rates generated from magnetic resonance imaging data [47]. normal iliac and right iliac pressure wave forms exhibit physiologic amplitudes and phase. For the impedance boundary conditions. This latter observation is quite interesting and perhaps due to the fact that during the deceleration phase in late systole. 195 (2006) 3776–3796 3789 from the aorta to the normal iliac artery is greater than that to the stenosed iliac artery throughout the cardiac cycle. following the 70/30 mean ﬂow split noted above. the inlet. . Engrg.I. Mech. superior mesenteric. The velocity ﬁelds for the two diﬀerent outlet boundary conditions exhibit substantial diﬀerences.49]. For the branch vessels feeding the viscera (celiac. The inlet pressure amplitude for the pressure boundary condition is not representative of physiologic conditions: it is solely determined by the instantaneous pressure gradient from the inlet to the prescribed constant outlets that is needed to drive the ﬂow to both outlets. blood is more easily decelerated in the normal iliac artery than would be expected for the stenosed iliac artery. For the impedance boundary condition we observe that while the mean ﬂow split is nearly 50/50. 8 shows the 3D model.

Engrg. Mech. 6. Vignon-Clementel et al.E. Velocity magnitude along the symmetry plane of the model at peak systole and early-diastole for the constant pressure and impedance outlet boundary conditions.3790 I. / Comput. Methods Appl. . 195 (2006) 3776–3796 Fig.

Mech.3 Pa.I. . Pressure at peak systole and early diastole for the constant pressure and impedance outlet boundary conditions. / Comput.E. 1 mmHg = 133. Engrg. Vignon-Clementel et al. Methods Appl. 195 (2006) 3776–3796 3791 Fig. 7.

1 mmHg = 133. Vignon-Clementel et al. Engrg. 1 cc/s = 10À6 m3/s. 8. / Comput.3792 I. . Mech. Pressure and ﬂow wave forms in a subject-speciﬁc model of the human abdominal aorta with a measured periodic inlet ﬂow rate and impedance outlet boundary conditions.3 Pa. Methods Appl.E. 195 (2006) 3776–3796 Fig.

The next example. Mech.E.1 Pa.I. . demonstrates that this approach can be used for complex multi-branched systems. Methods Appl. As long as the eﬀect of the downstream domain can be represented by an explicit function of pressure as a function of ﬂow rate or velocity. the methods described can be used to couple the upstream three-dimensional numerical domain with the downstream analytic domain. 4. 9. a patient speciﬁc abdominal aorta model. Results have been shown for idealized and patient speciﬁc 3D geometries. an otherwise symmetric model of an abdominal aortic bifurcation with an obstruction in one iliac. 8. using physiological values. A long straight cylindrical blood vessel is used to demonstrate that realistic blood pressures can be calculated using this new method and that the choice of the outlet boundary conditions has a signiﬁcant eﬀect on the computed pressure ﬁeld. Vignon-Clementel et al. The ﬁnal example. Lumped parameter models more complex than a simple resistance could be easily incorporated in a manner similar to that used for the impedance boundary condition. The numerical results presented demonstrate that physiologic values of pressure can be attained and illustrate the importance of using appropriate boundary conditions. Conclusions We have successfully developed and implemented a method to prescribe outﬂow boundary conditions intended for three-dimensional ﬁnite element simulations of blood ﬂow based on the Dirichlet-to-Neumann and variational multiscale methods. 195 (2006) 3776–3796 3793 Fig. velocity and pressure ﬁelds. Engrg. Mean wall shear stress over one cardiac cycle for the subject-speciﬁc abdominal aorta model depicted in Fig. 1 dyn/cm2 = 0. demonstrates that the choice of outlet boundary conditions can dramatically aﬀect the ﬂow distribution. coupled to more sophisticated downstream models that incorporate memory-eﬀects like the impedance boundary condition. / Comput.

D. Arch. Hemodynamics and atherosclerosis. Wang.P. Steele. does not model wave propagation from the three-dimensional to one-dimensional domains. Zarins. Hemodynamic Factors in Atherosclerosis. Parker. However. C. Acknowledgements This material is based upon work supported by the National Science Foundation under Grant No. Lab. [7] National Heart. the analyses performed clearly indicate the need for appropriate boundary conditions in computing pulse pressures.com). Ku. Taylor. Realistic values of blood pressure (mean and pulse) will be essential for obtaining accurate loading and displacement in ﬂuid-solid interaction methods. Mary Draney for acquiring the subject-speciﬁc abdominal aorta MRI data. Insights and perspectives gained from studies of human arteries. [2] A.S. Formaggia. Draney. Glagov. Methods Appl. B. J. Public Health Service. Comput. D. Experimental and computational methods in cardiovascular ﬂuid mechanics. 0205741 and a predoctoral fellowship from the American Heart Association. the authors gratefully acknowledge the assistance of Dr. A. J. C. 112 (10) (1988) 1018–1031. D. Multiscale modelling of the circulatory system: A preliminary analysis. M. Am. Farzin Shakib for his linear algebra package (http://www.A. Zarins. Kamiya. 2002. for a more realistic representation of ﬂow and pressure further analysis of the generation and validation of the impedance functions is needed. Lung and Blood Institute report of the task force on research in pediatric cardiovascular disease. Engrg. Mech. 36 (2004) 197–231. Finally. 195 (2006) 3776–3796 The stability of the solutions proved to be sensitive to the number of frequencies used to generate the impedance boundary condition. T.R. Finally. as such. Veneziani. F. Giddens. 2 (2/3) (1999) 75–83. J. [5] C. Aided Surgery 4 (5) (1999) 231–247. Alternate models based on physical measurements of branching patterns would aid in the speciﬁcation of realistic impedance functions. Biomech. Taylor.K. C. 25 (6) (1969) 677–686. non-periodic ﬂows or a coupling to the non-linear one-dimensional equations of blood ﬂow may be needed for non-periodic three-dimensional ﬂow problems. Ku.N. the method described may be extensible to other biological and non-biological ﬂow phenomena where the downstream model can be described as a function that links the primary variables or their derived quantities at the coupling interface. [8] N. It is important to note that the present implementation does not incorporate deformable vessels in the three-dimensional domain and.T. Rogge. National Institutes of Health. Comput.3794 I. [6] C. / Comput. Ann.B. Glagov.acusim. Company. Although these results are very encouraging. Stergiopulos. Circulation Res.T. [9] L.A.P. Adaptive regulation of wall shear stress to ﬂow change in the canine carotid artery. Physiol.K. Togawa. References [1] C. Vascular surgery: A Comprehensive Review. Zarins. W. 105–118. An alternate outﬂow boundary condition that incorporates transient. A. Wolinsky. 239 (1) (1980) H14–H21. Deviation of man from the usual pattern. Visualization Sci. Fluid Mech. Pathol. [3] H. pp. Draney. Comparison of abdominal and thoracic aortic medial structure in mammals. Nobile.S. Quarteroni. 25 (12) (1992) 1477–1488. Rev.N. Mette Olufsen for the use of her methods to compute input impedance of vascular trees and Dr. Med. Dr. The impedance functions were generated using a binary fractal tree that did not incorporate diﬀerences between the branching patterns in diﬀerent organs. T. and Hyun Jin Kim for constructing the abdominal aorta model.E. M. Nathan Wilson for assistance with software development. [4] S. K. A further limitation of the impedance boundary condition is that it is derived based on the assumption of periodicity. . US Department of Health and Human Services. Young. S. The authors gratefully acknowledge Dr. D.A.K. due to the convolution with the ﬂow rate history. 2002. Vignon-Clementel et al. Taylor. Computer simulation of arterial ﬂow with applications to arterial and aortic stenoses.F. Moore and W. Predictive medicine: computational techniques in therapeutic decision-making.

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