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Hemodynamic Characterization of Peripheral Arterio-venous Malformations

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Abstract

Peripheral arterio-venous malformations (pAVMs) are congenital vascular anomalies that require treatment, due to their severe clinical consequences. The complexity of lesions often leads to misdiagnosis and ill-planned treatments. To improve disease management, we developed a computational model to quantify the hemodynamic effects of key angioarchitectural features of pAVMs. Hemodynamic results were used to predict the transport of contrast agent (CA), which allowed us to compare our findings to digital subtraction angiography (DSA) recordings of patients. The model is based on typical pAVM morphologies and a generic vessel network that represents realistic vascular feeding and draining components related to lesions. A lumped-parameter description of the vessel network was employed to compute blood pressure and flow rates. CA-transport was determined by coupling the model to a 1D advection–diffusion equation. Results show that the extent of hemodynamic effects of pAVMs, such as arterial steal and venous hypertension, strongly depends on the lesion type and its vascular architecture. Dimensions of shunting vessels strongly influence hemodynamic parameters. Our results underline the importance of the dynamics of CA-transport in diagnostic DSA images. In this context, we identified a set of temporal CA-transport parameters, which are indicative of the presence and specific morphology of pAVMs.

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Abbreviations

AVM:

Arterio-venous malformation

cAVM:

Cerebral arterio-venous malformation

pAVM:

Peripheral arterio-venous malformation

MR:

Magnetic resonance

DSA:

Digital subtraction angiography

CA:

Contrast agent

LPM:

Lumped parameter model

ATA:

Anterior tibial artery

PTA:

Posterior tibial artery

FbA:

Fibular artery

MDA:

Medial and dorsal arteries in the foot

DA:

Digital arteries in the foot

DV:

Digital veins in the foot

MDV:

Medial and dorsal veins in the foot

PTV:

Posterior tibial vein

ATV:

Anterior tibial vein

FbV:

Fibular vein

GSV:

Great saphenous vein

SSV:

Small saphenous vein

CO:

Cardiac output

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Authors and Affiliations

  1. ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland

    Sabrina Frey & D. Obrist

  2. Division of Angiology, Swiss Cardiovascular Center, University of Bern, Bern University Hospital, Bern, Switzerland

    A. Haine, R. Kammer & I. Baumgartner

  3. Department of Diagnostic, Interventional and Pediatric Radiology, University of Bern, Bern University Hospital, Bern, Switzerland

    H. von Tengg-Kobligk

Authors
  1. Sabrina Frey
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  2. A. Haine
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Correspondence to Sabrina Frey.

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Associate Editor Kerry Hourigan oversaw the review of this article.

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Frey, S., Haine, A., Kammer, R. et al. Hemodynamic Characterization of Peripheral Arterio-venous Malformations. Ann Biomed Eng 45, 1449–1461 (2017). https://doi.org/10.1007/s10439-017-1821-9

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  • DOI: https://doi.org/10.1007/s10439-017-1821-9

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