Proceedings of the Institution of Mechanical Engineers,Part H: Journal of Engineering in Medicine

The replacement and bypass of arteries of diameter greater than 6 mm with textile vascular prostheses has proved very successful since they were first introduced forty years ago. Although manufacturers continue to improve their products and make them of consistent quality for increased safety and performance and to facilitate their use by surgeons, most of the research work in this area is concerned with the development of small-diameter prostheses. Current expanded PTFE and textile prostheses do not perform satisfactorily when their diameters are reduced to less than 6 mm. For the small-diameter prostheses it will be necessary to develop less thrombogenic materials and to design the structure of the prostheses more closely to match the mechanical properties of the natural arteries. The purpose of this paper is to discuss the design requirements and to review the development of large- and small-diameter vascular prostheses.

The principles and implementation of a method for measurement of blood flow waveforms from X-ray angiography are described. Contrast medium mass values are obtained at multitudinous positions along individual vessels and from numerous images in a time sequence. These values are represented as a matrix of grey levels in a parametric image. This image is normalized to represent contrast medium concentration, and the movement over time of isoconcentration portions of the contrast bolus is recovered to determine blood flow. Preliminary validation has been undertaken using parametric images generated in two ways: synthesis from a computer model of vascular pulsatile flow and analysis of cine-angiograms of physical models (plastic and perspex tubes) carrying known pulsatile flows. Two distinct methods for interrogation of parametric images by digital image processing were employed; both provided accurate flow measurements.

A method of measuring blood flow from X-ray angiograms recorded on cine film, by obtaining contrast mass values at numerous positions along individual vessels and at multiple instants of time, has been previously reported. In the present work it was hypothesized that the signal-to-noise limitations of recordings on video tape could be overcome by recording already-subtracted angiograms from a digital subtraction angiographic (DSA) system and that the spatial resolution of video was adequate to use a similar measurement method. Validation experiments were recorded, in which flows measured using a calibrated electromagnetic flowmeter passed through tubes of 4–7 mm diameter, during injections of 2–5 ml contrast medium. The video sequences were computer analysed and produced angiographic flow measurements agreeing with the electromagnetic flows to within 5 per cent. A case study of a clinical carotid artery DSA in a patient with secondary carcinoma metastases in the brain is described. It is concluded that accurate flow measurements can be made from DSA video recordings.

There is some evidence that the ratio of the blood flow to the liver through the hepatic artery to the total flow to the liver through the hepatic artery and portal vein (the hepatic arterial flow fraction, AFF) is altered in the presence of cirrhosis. Several methods have been published that seek to provide an index of this ratio. These indices are dependent on factors other than the AFF and cannot provide a true measure of it. The impulse retention function of the liver has two components and these may be derived using a model-driven deconvolution of the arterial tracer concentration curve and the curve of tracer concentration in the liver. The AFF may then be obtained from the relative heights of these two components. Simulation studies show that the AFF calculated using this method is reasonably accurate and a small clinical series shows that it is capable of appropriate clinical classification of patients into cirrhotic and non-cirrhotic groups.

A non-invasive radioisotope technique for the measurement of total liver blood flow (TBF) is described. The method requires the use of two intravenously administered tracers, ^99mTc (technetium 99m) human serum albumin (HSA) and ^99mTc colloid. Computer analysis of first-pass time activity curves for HSA for liver and lung tissues yields values for the arterial and portal contributions to liver blood flow, from which TBF can be determined. These values are then corrected for attenuation using the images of the colloid distribution. The use of the method is illustrated in 17 subjects. Assumptions, limitations and possible applications of the technique are discussed.

In order to establish underlying mechanisms responsible for the vasospastic disorder vibration white finger (VWF), the acute effect of vibration on digital blood flow was assessed. Thirteen patients with primary Raynaud's phenomenon (RP), 15 patients with VWF and 13 controls were exposed to acute vibration in the middle digit of one hand for 1 and 3 minutes. Blood flow was measured in that digit and in the middle finger of the contralateral hand using strain gauge plethysmography before and after vibration. The measurements were then repeated following digital nerve blockade using 2% Lignocaine in the vibrated digit. The results demonstrate that vibration affects digital blood flow through two independent mechanisms. Vibration appears to cause both an axonal vasoconstrictor reflex and an active local vasodilation phenomenon. In patients with established vasospastic disorders this vasoconstrictor reflex is exaggerated.

In health, valves in the deep veins function unidirectionally permitting blood flow towards the heart. This function is often degraded following deep vein thrombosis leading to venous hypertension and disturbed haemodynamics in the legs of the patient. Hypertension, in turn, promotes venous ulceration through a series of degenerative pathological steps. Traditional methods of treatment include leg elevation and compression using elasticated garments or bandaging. These techniques manage the problem with varying success but do not cure it. Recent advances in surgical research suggest that novel techniques are being developed for treating valve incompetence. In these circumstances, vascular scientists should be examining methods of addressing both the macro- and the microcirculation so that changes in these consequent to venous hypertension may be measured. This review examines existing methods of measuring the macrocirculation as well as the potential techniques to study effects of venous haemodynamics in the microcirculation.