Effect of lower limb amputation on hemodynamic environment of the left coronary artery: a numerical study_Journal of Biomedical Engineering

Authors：

TAI Tianxiang ^1,2 ,  JIANG Wentao ^1,2 , LI Zhongyou ^1,2 , DIAO Junjie ^1,2 , LI Xiao ^1,2

1. Department of Mechanics & Engineering, Sichuan University, Chengdu 610065, P. R. China;
2. Biomechanical Engineering Laboratory, Sichuan University, Chengdu 610065, P. R. China;

Corresponding author：

JIANG Wentao, Email: scubme@aliyun.com

Keywords：

Coronary artery; Lower extremity amputation; Hemodynamics; Cardiovascular disease

DOI：

10.7507/1001-5515.202401066

Video：

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It has been found that the incidence of cardiovascular disease in patients with lower limb amputation is significantly higher than that in normal people, and the risk of developing coronary atherosclerosis is much higher than that in other high-risk groups. Numerous studies have confirmed that high systolic and diastolic blood pressures are potential risk factors for coronary artery disease, and it has been demonstrated that the ascending aortic pressure during diastole increases after amputation. However, the relationship between lower limb amputation and coronary atherosclerosis has not been fully explained from the perspective of hemodynamic environment. Therefore, in this study, a centralized parameter model of the human cardiovascular system and a three-dimensional model of the left coronary artery were established to investigate the effect of amputation on the hemodynamic environment of the coronary artery. The results showed that the abnormal hemodynamic environment induced by amputation, characterized by factors such as increased diastolic pressure in the ascending aorta, led to a significant expansion of the low wall shear stress (WSS) region on the outer lateral aspect of the left coronary artery bifurcation during diastole. The maximum observed increase in the area of low WSS reached up to 50.5%. This abnormal hemodynamic environment elevates the risk of plaque formation in the left coronary artery. Moreover, the more severe the lower limb atrophy, the greater the risk of coronary atherosclerosis in amputees. This study preliminarily revealed the effect of lower limb amputation on the hemodynamic environment of the left coronary artery.

1.	国家康复辅具研究中心. 我国假肢与矫形器行业的历史、现状、展望. 北京: 国家康复辅具研究中心, 2021.
2.	Molina C S, Faulk J. Lower eextremity aamputation. Treasure Island: StatPearls Publishing, 2020.
3.	Vollmar J, Pauschinger P, Paes E, et al. Aortic aneurysms as late sequelae of above-knee amputation. Lancet, 1989, 334(8667): 834-835.
4.	Stewart C, Jain A. Cause of death of lower limb amputees. Prosthet Orthot Int, 1992, 16(2): 129-132.
5.	Modan M, Peles E, Halkin H, et al. Increased cardiovascular disease mortality rates in traumatic lower limb amputees. Am J Cardiol, 1998, 82(10): 1242-1247.
6.	Nallegowda M, Lee E, Brandstater M, et al. Amputation and cardiac comorbidity: analysis of severity of cardiac risk. PM R, 2012, 4(9): 657-666.
7.	Liao F Y, Garrison D W, Jan Y K. Relationship between nonlinear properties of sacral skin blood flow oscillations and vasodilatory function in people at risk for pressure ulcers. Microvasc Res, 2010, 80(1): 44-53.
8.	刁珺杰, 蒋文涛, 李忠友, 等. 下肢截肢患者心血管系统集中参数模型的血流动力学数值研究. 工程力学, 2023, 40(4): 233-242.
9.	Dong R Q, Jiang W T, Zhang M, et al. Hemodynamic studies for lower limb amputation and rehabilitation. J Mech Med Biol, 2015, 15(4): 1530005.
10.	Reneman R S, Arts T, Hoeks A P. Wall shear stress-an important determinant of endothelial cell function and structure-in the arterial system in vivo: discrepancies with theory. J Vasc Res, 2006, 43(3): 251-269.
11.	Pietrabissa R, Mantero S, Marotta T, et al. A lumped parameter model to evaluate the fluid dynamics of different coronary bypasses. Med Eng Phys, 1996, 18(6): 477-484.
12.	Rehman S, Khan A, Rehman A, et al. Physiology, coronary circulation. Treasure Island: StatPearls Publishing, 2023.
13.	Dong J L, Sun Z H, Inthavong K, et al. Fluid-structure interaction analysis of the left coronary artery with variable angulation. Comput Methods Biomech Biomed Eng, 2015, 18(14): 1500-1508.
14.	Chaichana T, Sun Z, Jewkes J. Computation of hemodynamics in the left coronary artery with variable angulations. J Biomech, 2011, 44(10): 1869-1878.
15.	Nomura T, Lebowitz L, Koide Y, et al. Evaluation of hepatic venous flow using transesophageal echocardiography in coronary artery bypass surgery: an index of right ventricular function. J Cardiothorac Vasc Anesth, 1995, 9(1): 9-17.
16.	Müller L O, Toro E F. A global multiscale mathematical model for the human circulation with emphasis on the venous system. Int J Numer Method Biomed Eng, 2014, 30(7): 681-725.
17.	Li Z Y, Jiang W T, Diao J J, et al. Segmentary strategy in modeling of cardiovascular system with blood supply to regional skin. Biocybern Biomed Eng, 2021, 41(4): 1505-1517.
18.	Kim H J, Vignon-Clementel I, Coogan J, et al. Patient-specific modeling of blood flow and pressure in human coronary arteries. Ann Biomed Eng, 2010, 38(10): 3195-3209.
19.	Soulis J V, Farmakis T M, Giannoglou G D, et al. Wall shear stress in normal left coronary artery tree. J Biomech, 2006, 39(4): 742-749.
20.	李鲍. 基于血流动力学效应优化的体外反搏个性化治疗策略研究. 北京: 北京工业大学, 2021.
21.	Poredos P, Poredos A V, Gregoric I. Endothelial dysfunction and its clinical implications. Angiology, 2021, 72(7): 604-615.
22.	Ku D N, Giddens D P, Zarins C K, et al. Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis, 1985, 5(3): 293-302.
23.	Karner G, Perktold K, Hofer M, et al. Flow characteristics in an anatomically realistic compliant carotid artery bifurcation model. Comput Methods Biomech Biomed Eng, 1999, 2(3): 171-185.
24.	Katritsis D, Kaiktsis L, Chaniotis A, et al. Wall shear stress: theoretical considerations and methods of measurement. Prog Cardiovasc Dis, 2007, 49(5): 307-329.
25.	Friedman M, Deters O. Correlation among shear rate measures in vascular flows. J Biomech Eng, 1987, 109(1): 25-26.
26.	Nordgaard H, Swillens A, Nordhaug D, et al. Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model. Cardiovasc Res, 2010, 88(3): 512-519.
27.	Braun J, Oldendorf M, Moshage W, et al. Electron beam computed tomography in the evaluation of cardiac calcifications in chronic dialysis patients. Am J Kidney Dis, 1996, 27(3): 394-401.
28.	Goodman W G, Goldin J, Kuizon B D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med, 2000, 342(20): 1478-1483.
29.	Avolio A P. Multi-branched model of the human arterial system. Med Biol Eng Comput, 1980, 18(6): 709-718.
30.	Bader H. Dependence of wall stress in the human thoracic aorta on age and pressure. Circ Res, 1967, 20(3): 354-361.
31.	Kannel W B. Contributions of the Framingham Study to the conquest of coronary artery disease. Am J Cardiol, 1988, 62(16): 1109-1112.
32.	Witteman J C, Grobbee D E, Valkenburg H A, et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet, 1994, 343(8896): 504-507.
33.	Malek A M, Alper S L, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA, 1999, 282(21): 2035-2042.
34.	Zarins C K, Giddens D P, Bharadvaj B, et al. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res, 1983, 53(4): 502-514.
35.	Caro C, Fitz-Gerald J, Schroter R. Arterial wall shear and distribution of early atheroma in man. Nature, 1969, 223(5211): 1159-1161.
36.	Friedman M H, Hutchins G M, Bargeron C B, et al. Correlation between intimal thickness and fluid shear in human arteries. Atherosclerosis, 1981, 39(3): 425-436.
37.	Fard B, Dijkstra P U, Voesten H G, et al. Mortality, reamputation, and preoperative comorbidities in patients undergoing dysvascular lower limb amputation. Ann Vasc Surg, 2020, 64: 228-238.
38.	Hoffstad O, Mitra N, Walsh J, et al. Diabetes, lower-extremity amputation, and death. Diabetes Care, 2015, 38(10): 1852-1857.
39.	Marcus J T, Smeenk H G, Kuijer J P, et al. Flow profiles in the left anterior descending and the right coronary artery assessed by MR velocity quantification: effects of through-plane and in-plane motion of the heart. J Comput Assist Tomogr, 1999, 23(4): 567-576.

1. 国家康复辅具研究中心. 我国假肢与矫形器行业的历史、现状、展望. 北京: 国家康复辅具研究中心, 2021.
2. Molina C S, Faulk J. Lower eextremity aamputation. Treasure Island: StatPearls Publishing, 2020.
3. Vollmar J, Pauschinger P, Paes E, et al. Aortic aneurysms as late sequelae of above-knee amputation. Lancet, 1989, 334(8667): 834-835.
4. Stewart C, Jain A. Cause of death of lower limb amputees. Prosthet Orthot Int, 1992, 16(2): 129-132.
5. Modan M, Peles E, Halkin H, et al. Increased cardiovascular disease mortality rates in traumatic lower limb amputees. Am J Cardiol, 1998, 82(10): 1242-1247.
6. Nallegowda M, Lee E, Brandstater M, et al. Amputation and cardiac comorbidity: analysis of severity of cardiac risk. PM R, 2012, 4(9): 657-666.
7. Liao F Y, Garrison D W, Jan Y K. Relationship between nonlinear properties of sacral skin blood flow oscillations and vasodilatory function in people at risk for pressure ulcers. Microvasc Res, 2010, 80(1): 44-53.
8. 刁珺杰, 蒋文涛, 李忠友, 等. 下肢截肢患者心血管系统集中参数模型的血流动力学数值研究. 工程力学, 2023, 40(4): 233-242.
9. Dong R Q, Jiang W T, Zhang M, et al. Hemodynamic studies for lower limb amputation and rehabilitation. J Mech Med Biol, 2015, 15(4): 1530005.
10. Reneman R S, Arts T, Hoeks A P. Wall shear stress-an important determinant of endothelial cell function and structure-in the arterial system in vivo: discrepancies with theory. J Vasc Res, 2006, 43(3): 251-269.
11. Pietrabissa R, Mantero S, Marotta T, et al. A lumped parameter model to evaluate the fluid dynamics of different coronary bypasses. Med Eng Phys, 1996, 18(6): 477-484.
12. Rehman S, Khan A, Rehman A, et al. Physiology, coronary circulation. Treasure Island: StatPearls Publishing, 2023.
13. Dong J L, Sun Z H, Inthavong K, et al. Fluid-structure interaction analysis of the left coronary artery with variable angulation. Comput Methods Biomech Biomed Eng, 2015, 18(14): 1500-1508.
14. Chaichana T, Sun Z, Jewkes J. Computation of hemodynamics in the left coronary artery with variable angulations. J Biomech, 2011, 44(10): 1869-1878.
15. Nomura T, Lebowitz L, Koide Y, et al. Evaluation of hepatic venous flow using transesophageal echocardiography in coronary artery bypass surgery: an index of right ventricular function. J Cardiothorac Vasc Anesth, 1995, 9(1): 9-17.
16. Müller L O, Toro E F. A global multiscale mathematical model for the human circulation with emphasis on the venous system. Int J Numer Method Biomed Eng, 2014, 30(7): 681-725.
17. Li Z Y, Jiang W T, Diao J J, et al. Segmentary strategy in modeling of cardiovascular system with blood supply to regional skin. Biocybern Biomed Eng, 2021, 41(4): 1505-1517.
18. Kim H J, Vignon-Clementel I, Coogan J, et al. Patient-specific modeling of blood flow and pressure in human coronary arteries. Ann Biomed Eng, 2010, 38(10): 3195-3209.
19. Soulis J V, Farmakis T M, Giannoglou G D, et al. Wall shear stress in normal left coronary artery tree. J Biomech, 2006, 39(4): 742-749.
20. 李鲍. 基于血流动力学效应优化的体外反搏个性化治疗策略研究. 北京: 北京工业大学, 2021.
21. Poredos P, Poredos A V, Gregoric I. Endothelial dysfunction and its clinical implications. Angiology, 2021, 72(7): 604-615.
22. Ku D N, Giddens D P, Zarins C K, et al. Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive correlation between plaque location and low oscillating shear stress. Arteriosclerosis, 1985, 5(3): 293-302.
23. Karner G, Perktold K, Hofer M, et al. Flow characteristics in an anatomically realistic compliant carotid artery bifurcation model. Comput Methods Biomech Biomed Eng, 1999, 2(3): 171-185.
24. Katritsis D, Kaiktsis L, Chaniotis A, et al. Wall shear stress: theoretical considerations and methods of measurement. Prog Cardiovasc Dis, 2007, 49(5): 307-329.
25. Friedman M, Deters O. Correlation among shear rate measures in vascular flows. J Biomech Eng, 1987, 109(1): 25-26.
26. Nordgaard H, Swillens A, Nordhaug D, et al. Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA-LAD model. Cardiovasc Res, 2010, 88(3): 512-519.
27. Braun J, Oldendorf M, Moshage W, et al. Electron beam computed tomography in the evaluation of cardiac calcifications in chronic dialysis patients. Am J Kidney Dis, 1996, 27(3): 394-401.
28. Goodman W G, Goldin J, Kuizon B D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med, 2000, 342(20): 1478-1483.
29. Avolio A P. Multi-branched model of the human arterial system. Med Biol Eng Comput, 1980, 18(6): 709-718.
30. Bader H. Dependence of wall stress in the human thoracic aorta on age and pressure. Circ Res, 1967, 20(3): 354-361.
31. Kannel W B. Contributions of the Framingham Study to the conquest of coronary artery disease. Am J Cardiol, 1988, 62(16): 1109-1112.
32. Witteman J C, Grobbee D E, Valkenburg H A, et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet, 1994, 343(8896): 504-507.
33. Malek A M, Alper S L, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA, 1999, 282(21): 2035-2042.
34. Zarins C K, Giddens D P, Bharadvaj B, et al. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res, 1983, 53(4): 502-514.
35. Caro C, Fitz-Gerald J, Schroter R. Arterial wall shear and distribution of early atheroma in man. Nature, 1969, 223(5211): 1159-1161.
36. Friedman M H, Hutchins G M, Bargeron C B, et al. Correlation between intimal thickness and fluid shear in human arteries. Atherosclerosis, 1981, 39(3): 425-436.
37. Fard B, Dijkstra P U, Voesten H G, et al. Mortality, reamputation, and preoperative comorbidities in patients undergoing dysvascular lower limb amputation. Ann Vasc Surg, 2020, 64: 228-238.
38. Hoffstad O, Mitra N, Walsh J, et al. Diabetes, lower-extremity amputation, and death. Diabetes Care, 2015, 38(10): 1852-1857.
39. Marcus J T, Smeenk H G, Kuijer J P, et al. Flow profiles in the left anterior descending and the right coronary artery assessed by MR velocity quantification: effects of through-plane and in-plane motion of the heart. J Comput Assist Tomogr, 1999, 23(4): 567-576.

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Latest ArticlesEffect of lower limb amputation on hemodynamic environment of the left coronary artery: a numerical study

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