肾动脉狭窄形态对其血流动力学影响研究
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1.四川大学应用力学系;2.四川大学华西医院血管外科;3.北京航空航天大学生物科学与医学工程学院

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国家自然科学基金(11827803和11421202)


Influence of renal artery stenosis morphology on renal artery hemodynamics
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1.Sichuan University;2.Department of Vascular surgery, West China Hospital, Sichuan University;3.Department of Applied Mechanics, Sichuan University;4.Department of Vascular surgery, West China Hospital, Sichuan University,

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    摘要:

    目的 目前临床对肾动脉狭窄严重程度分级仅依赖于狭窄程度,忽略了其它重要的形态学参数,从而可能导致对临床治疗方案的误判。本研究利用计算流体动力学技术,探讨肾动脉狭窄的面积、对称性、长度和形状对肾动脉狭窄血流动力学的影响。方法 本文创建了理想化的腹主动脉模型,并对肾动脉狭窄四项形态学参数:狭窄的面积、对称性、长度和形状进行了独立研究分析。本研究发现肾灌注、压降和壁面剪切力分布与狭窄面积有显著关系。结果 当狭窄面积大于70%时,所有血流动力学参数变化明显。此外,狭窄对称性对RAS中的回流区有明显的影响,但狭窄长度和狭窄形状对肾动脉的血流动力学影响不大。结论 虽然狭窄面积仍是肾动脉狭窄各种形态参数中最显著的影响因素,但是其它形态学参数尤其是非对称狭窄对肾动脉血流动力学影响也不可忽略,因此临床医生的治疗方案应该是基于这些形态学参数的一个综合评估。

    Abstract:

    Objective Currently, the clinical classification of severity of renal artery stenosis (RAS) solely depends on the stenosis degree, ignoring additional important morphological parameters, which may lead to errors when planning clinical treatment to patients. Method This study uses computational fluid dynamics (CFD) to explore the hemodynamic effects of stenosis area (AS), symmetry, length and shape on the renal artery following stenosis development. Idealized abdominal aorta models with main branches including narrow renal arteries were created. The area, symmetry, length and shape of stenosis were analyzed in four separate parametric studies. Results In this study, it was found that renal perfusion, pressure drop and wall shear stress distribution in renal artery stenosis were significantly correlated with stenosis area. When the stenosis area was greater than 70%, all hemodynamic parameters changed significantly. In addition, the symmetry of stenosis had obvious effect on the reflux area after renal artery stenosis, but the length and shape of stenosis had little effect on the hemodynamics of renal artery. Conclusion Although AS is still the most significant influencing factor in RAS, other morphological parameters, especially asymmetric stenosis, can not be neglected. Therefore, clinical treatment plans should be a comprehensive evaluation based on these morphological parameters.

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  • 收稿日期:2020-05-22
  • 最后修改日期:2020-07-16
  • 录用日期:2020-07-16
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