Biomedical Engineering Reference
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Fig. 12.5 Segmented clinical imaging data depicting IAs ( a 1 - d 1 ). IAs are removed the geometry
of the healthy artery reconstructed ( a 2 - d 2 ). Computational models of IAs on patient specific ge-
ometries with degradation of elastin linked to low WSS ( a 2 - d 2 ). The color-map depicts WSS (Pa)
12.4 Discussion
In this chapter, we first (briefly) reviewed the application of CFD models to inves-
tigate IA inception and presented a novel methodology for reconstructing the ge-
ometry of the healthy artery prior to IA formation. We investigated the correlation
between IA inception and the spatial distribution of several hemodynamic indices
(WSS, WSSG, OSI, AFI and GON) for 22 clinical cases depicting sidewall IAs.
To our knowledge this is the largest (and most complete) CFD inception study, of
its kind, to date. Consistent with previous observations, we observed that locations
of aneurysm formation (LAF) occur in regions of the artery subject to high WSS.
However, correlation of LAF with indices that characterize the oscillatory nature of
the flow, i.e. OSI and min(AFI), do not seem as strong as (sometimes) previously
observed. Hence, we suggest care should be taken: (i) when interpreting conclusions
of studies which have been deduced from a small number of clinical cases; (ii) ar-
ticulating the significance of conclusions of CFD studies which involve relatively
few cases. Moreover, we point out that whilst CFD has a role to play in guiding our
understanding of vascular disease, it needs to be coupled with improved modeling
(and understanding) of the mechanobiology of the arterial wall to gain real insight
into the aetiology of vascular disease. This motivates the need for multi-scale mod-
els which integrate the biology and the (solid and fluid) biomechanics of the arterial
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