Hemodynamics of aneurysm intervention with different stents

An ideal cerebral aneurysm model with different stent forms is established. By using the single-relaxation-time (SRT) lattice Boltzmann method (LBM) to solve the flow field, the blood flow characteristics in the aneurysm under different conditions are studied numerically. The intra-arterial stenting of saccular aneurysms at different Reynolds numbers and the feasibility of new stenting forms such as double stenting and variable-spacing stenting in the aneurysms are explored. The hemodynamic factors such as velocity distribution and wall shear stress (WSS) in the aneurysm are analyzed. Numerical results show that the risk of aneurysm rupture is mainly centralized at the right corner of the aneurysm. Intervention of stents in the aneurysm can effectively reduce the intra-aneurysmal velocity and WSS, and decrease the danger of aneurysm rupture during strenuous exercise or emotional excitement. At the same time, the intervention of a double stent and the stent shape with a dense anterior part in the aneurysm has certain advantages in preventing aneurysm rupture. The intra-aneurysmal mean velocity reduction can reach 90.39% and 80.29% after the intervention of the double stent and the anterior densified stent respectively.     

Fluoroscopically triggered contrast-enhanced 3D MR DSA and 3D time-of-flight turbo MRA of the carotid arteries: first clinical experiences in correlation with ultrasound, x-ray angiography, and endarterectomy findings

The aim of this article was to obtain initial experiences with fluoroscopically triggered contrast-enhanced (CE) 3D MR DSA with elliptical centric k-space order and 3D time-of-flight (TOF) turbo MRA of the carotid arteries. In this prospective study we examined 16 consecutive patients with suspicion of atherosclerotic disease involving the carotid arteries. Ultrasound was available in all, x-ray angiography in 12, surgical correlation in 9, and intraoperative x-ray angiography in 4 patients. All examinations were done on a 1.5 T unit applying: transverse plain 3D TOF turbo MRA and coronal CE MRA with fluoroscopic triggering. Combining head and neck array coils allowed the visualization of supraaortic arteries from the aortic arch to the circle of Willis. MRA results (maximum intensity projections) were compared with x-ray angiography, ultrasound, and inspection of endarterectomy specimens. Volume rendering was performed in selected cases additionally. Agreement between CE MRA, 3D TOF turbo MRA and x-ray angiography regarding stenoses of the internal and external carotid artery was very good. CE MRA was able to detect correctly intracranial stenoses, but delineation of the aortic arch and proximal common carotid arteries was sometimes reduced. Volume rendering was suited for visualization of MRA images providing a realistic three-dimensional impression. In conclusion, high-resolution fluoroscopically triggered CE MRA as non-invasive technique is another important step on the way to replace invasive x-ray angiography for the evaluation of atherosclerotic carotid artery disease. High resolution 3D TOF turbo MRA might be a helpful adjunct to increase the diagnostic reliability for the carotid bifurcation.     

Noncontrast dynamic MRA in intracranial arteriovenous malformation (AVM), comparison with time of flight (TOF) and digital subtraction angiography (DSA)

Digital subtraction angiography (DSA) remains the gold standard to diagnose intracranial arteriovenous malformations (AVMs) but is invasive. Existing magnetic resonance angiography (MRA) is suboptimal for assessing the hemodynamics of AVMs. The objective of this study was to evaluate the clinical utility of a novel noncontrast four-dimensional (4D) dynamic MRA (dMRA) in the evaluation of intracranial AVMs through comparison with DSA and time-of-flight (TOF) MRA. Nineteen patients (12 women, mean age 26.2±10.7 years) with intracranial AVMs were examined with 4D dMRA, TOF and DSA. Spetzler-Martin grading scale was evaluated using each of the above three methods independently by two raters. Diagnostic confidence scores for three components of AVMs (feeding artery, nidus and draining vein) were also rated. Kendall's coefficient of concordance was calculated to evaluate the reliability between two raters within each modality (dMRA, TOF, TOF plus dMRA). The Wilcoxon signed-rank test was applied to compare the diagnostic confidence scores between each pair of the three modalities. dMRA was able to detect 16 out of 19 AVMs, and the ratings of AVM size and location matched those of DSA. The diagnostic confidence scores by dMRA were adequate for nidus (3.5/5), moderate for feeding arteries (2.5/5) and poor for draining veins (1.5/5). The hemodynamic information provided by dMRA improved diagnostic confidence scores by TOF MRA. As a completely noninvasive method, 4D dMRA offers hemodynamic information with a temporal resolution of 50-100 ms for the evaluation of AVMs and can complement existing methods such as DSA and TOF MRA.     

Magnetic resonance angiographic demonstration of carotid-cavernous fistula using elliptical centric time resolved imaging of contrast kinetics (EC-TRICKS)

Magnetic resonance angiographic evaluation of the intracranial vasculature has been predominantly carried out using conventional angiographic techniques such as time of flight and phase contrast sequences. These techniques have good spatial resolution but lack temporal resolution. Newer faster angiographic techniques have been developed to circumvent this limitation. Elliptical centric time-resolved imaging of contrast kinetics (EC-TRICKS) is one such technique which has combined the use of elliptical centric ordering of the k-space with multiphase 3D digital subtraction MR angiogram (MRA) to achieve excellent temporal resolution of the arterial and venous circulations. Its applications have been mainly in the peripheral vasculature. We report the use of this technique in a case of a high-flow, direct carotid-cavernous fistula to demonstrate its potential in intracranial MR angiography.     

High-resolution intracranial MRA at 7T using autocalibrating parallel imaging: initial experience in vascular disease patients

Purpose

Greater spatial resolution in intracranial three-dimensional time-of-flight (TOF) magnetic resonance angiography (MRA) is possible at higher field strengths, due to the increased contrast-to-noise ratio (CNR) from the higher signal-to-noise ratio and the improved background suppression. However, at very high fields, spatial resolution is limited in practice by the acquisition time required for sequential phase encoding. In this study, we applied parallel imaging to 7T TOF MRA studies of normal volunteers and patients with vascular disease, in order to obtain very high resolution (0.12 mm³) images within a reasonable scan time.

Materials and Methods

Custom parallel imaging acquisition and reconstruction methods were developed for 7T MRA, based on generalized autocalibrating partially parallel acquisition (GRAPPA). The techniques were compared and applied to studies of seven normal volunteers and three patients with cerebrovascular disease.

Results

The technique produced high resolution studies free from discernible reconstruction artifacts in all subjects and provided excellent depiction of vascular pathology in patients.

Conclusions

7T TOF MRA with parallel imaging is a valuable noninvasive angiographic technique that can attain very high spatial resolution.     

Quantitative 3D VUSE pulmonary MRA

The purposes of this study were to quantitatively evaluate a free-breathing three-dimensional (3D) variable angle uniform signal excitation (VUSE) magnetic resonance angiography (MRA) technique in normal volunteers, to demonstrate breathold 3D VUSE MRA in a normal volunteer, and to investigate the ability of the free-breathing 3D VUSE MRA technique to quantify differential flow in lung transplant patients. A free-breathing 3D VUSE MRA pulse sequence was run on the right lungs of 15 normal volunteers and both lungs of eight single or double lung transplant patients. A breathold scan was also used on one volunteer. No contrast agents were used. Normal lung MRA images were analyzed for maximum level of branching observed and minimum distance between distal vessels seen and the pleura. In patients, differential flow was determined with a program that counted the number of MRA pixels over a threshold signal level in each lung. These values were compared to radionuclide perfusion (Q) scan results. Average observed branching order in normal lung images was 5.9 +/- 0.7. Average distance between the most peripheral vessels seen and the pleura was 0.9 cm. Differential blood flow measured by pulmonary MRA was well correlated with that measured by Q scan (R2 = 0.84, p < 0.005). In addition to providing good visualization of normal pulmonary vessels, this technique was demonstrated to provide accurate estimates of differential blood flow in lung transplant patients free of serious lung scarring.     

In Vitro Model of Arterial Stenosis: Correlation of MR Signal Dephasing and Trans-Stenotic Pressure Gradients

Purpose: Turbulent flow just distal to stenoses causes signal loss (dephasing) on magnetic resonance angiography (MRA). This study correlates dephasing with trans-stenotic pressure gradients in an in vitro model of arterial stenosis.Materials and methods: Three-dimensional (3D) phase contrast, 2D time-of-flight, and 3D spoiled gradient echo MRA with/without gadolinium and varied echo time were performed for a system consisting of a peristaltic perfusion pump and a silastic vessel with stenoses of varying caliber. Length and diameter of dephasing jets were measured, and volumes calculated at varying pressure gradients and echo times, then correlated with percentage cross-sectional area stenosis as measured by conventional angiography.Results: Dephasing occurred in all sequences at pressure gradients of ≥4 mmHg (1 mmHg = 133 Pa) and stenoses of greater than 70%, and varied directly with pressure gradient. The dephasing was greatest for 3D phase contrast (PC). Gadolinium did not diminish dephasing.Conclusions: MRA signal dephasing at stenoses varies directly with pressure gradient. MRA may provide a non-invasive means for determining the hemodynamic significance of arterial stenoses.     

Combined renal MRA and perfusion with a single dose of contrast

Both anatomical and functional scans are often performed when diagnosing renovascular diseases, which in many cases require two separate contrast injections. With nephrogenic systemic fibrosis being associated with gadolinium, minimizing contrast injection dosage is desirable. In this study, a technique which performs time-resolved renal magnetic resonance angiography (MRA) and perfusion with a single scan and single dose of contrast has been evaluated in six healthy volunteers. A previously developed three-dimensional MRA technique called Contrast-enhanced Angiography with Multi-Echo and Radial k-space (CAMERA) has been used to acquire images, and perfusion analysis was performed using deconvolution methods. Time-resolved MRA, as well as renal blood flow, renal volume of distribution and mean transit time maps, were acquired.     

7 Tesla MRA for the differentiation between intracranial aneurysms and infundibula

ObjectiveThe differentiation between an aneurysm and an infundibulum with time-of-flight MRA is often difficult. However, this distinction is important because it affects further patient follow-up. The purpose of this study was to assess the added value of high resolution 7 Tesla MRA for investigating small vascular lesions suspect for an aneurysm or an infundibulum.Materials and methodsWe included patients in whom an intracranial vascular lesion was detected in our University Hospital and in whom the discrimination between a true aneurysms or an infundibulum could not be made on conventional 1.5 or 3 T MRI were included in the study. All patients underwent an additional 7 T time-of-flight MRA at higher spatial resolution.ResultsWe included 6 patients. The age range of the patients was 35–65 years and 5 of them were women. 1 out of 6 had a 1.5 T MRI, the other 5 patients had a 3 T MRI previous to the 7 T MRI. The lesion size varied between 0.9 mm and 2.0 mm. In 5 of the 6 patients the presence of an infundibulum could be proven using the high resolution of the 7 T MRA. All patients tolerated the 7 T MRI well.ConclusionOur results suggest that high resolution and contrast of 7 T MRA provides added diagnostic value in discriminating between intracranial aneurysms and infundibula. This finding may have important consequences for patient follow-up and comfort because it might reduce unnecessary follow-up exams and decrease uncertainty about the diagnosis. Larger studies, however, are needed to confirm our findings.     

Virtual cisternoscopy of intracranial vessels: a novel visualization technique using virtual reality

This paper introduces a different visualization method which we call “virtual cisternoscopy” using 3D MRA data sets. Virtual cisternoscopy uses well known tools, such as perspective volume rendering (pVR), fly-through techniques, and interactive visualization and combines them to a new approach featuring motion to resolve spatial relationships of intracranial vessels and vascular malformations. With a dedicated flight protocol extraluminal topography of intracranial arteries was analyzed using pVR. For evaluation of difficult vascular malformations extraluminal views are necessary. Therefore, movies of pVR views were produced simulating virtual tracks of neurosurgical flexible endoscopes, by flying around the intracranial vessels and vascular malformations within the cisterns. Endoluminal views were acquired additionally for precise evaluation of cases with complex vessel topography. Two healthy volunteers and three patients were examined. Comparing MIP and pVR images relevant advantages of pVR were found, such as depth information, perspective, lighting, and color. In contrast to MIP and source images of the MRA data set, virtual cisternoscopy of an aneurysm of the left middle cerebral artery demonstrated clearly an early origin of an artery in the region of the aneurysm neck/sac. In this case only virtual cisternoscopy led to the correct therapeutical decision. In a newborn, the type of a vein of Galen aneurysmal malformation could only be evaluated reliably by means of virtual cisternoscopy. The third case of a patient with a clipped aneurysm was evaluated more easily with virtual cisternoscopy than with DSA. In conclusion, virtual cisternoscopy may improve the pretherapeutical visualization of intracranial vascular malformations.     

Magnetic resonance angiography of dialysis access shunts: Initial results

The objective of this study was the feasibility of imaging hemodialysis fistulae with magnetic resonance angiography (MRA). MRA was performed in eight Brescia-Cimino fistulae and seven goretex loop grafts, five of which were stenosed and 10 normal. We compared two MRA methods: a 2D magnetization prepared turbo field echo (MPTFE) and a 3D phase contrast (PC) sequence. Digital subtraction angiography served as the gold standard. MPTFE MRA provided satisfactory quality images of the entire fistula in 14 out of 15 cases, and PC MRA in 9 of 15 cases (p < .05). MPTFE MRA identified all eight stenoses with one false-positive result. PC MRA identified seven of eight stenoses with two false positives. It is feasible to obtain diagnostic images of dialysis fistulae with MRA.     

Diagnosing Aortic Stenosis Using Phase Contrast MRI: Comparison with Echocardiography Depending on the Image Plane

This study intended to suggest a better method of measuring the precise peak velocity of the bloodstream of a patient suffering from aortic stenosis (AS) with a view to improving the reliability of the magnetic resonance imaging (MRI) scan. The study targeted 23 patients whose direction of the stenotic flow jet was different from that of the blood vessel among the patients who were diagnosed with a moderate or higher level of AS on echocardiography. The phase-contrast (PC) MRI was used for quantitatively measuring the bloodstream velocity. The examination was accomplished according to the two different image plane selection methods in the same patient. After placing the image planes perpendicular to the blood vessel and the stenotic flow jet, respectively, we obtained the two velocity encoded images to calculate the peak blood velocities to compare them with the measurement results from an echocardiography scan. According to the comparison results of the peak blood velocities, echocardiography showed a mean peak blood velocity of 4.19 ± 1.05 m/s. On the PC MRI scan, the peak blood velocity was 3.11 ± 0.77 m/s when the image plane was perpendicular to the blood vessel and 3.58 ± 0.87 m/s when the image plane was placed perpendicular to the stenotic flow jet. As a result, if PC MRI is used to measure the peak blood velocity for patients with AS, then the image plane must be placed perpendicular to the stenotic flow jet, instead of perpendicular to the blood vessel, to provide a more precise value of a low blood velocity.     

Magnetic resonance imaging and pulsed Doppler sonography of poststenotic jets: Correlation between signal void and flow velocity distribution

To correlate the appearance of poststenotic jets on gradient echo images with features of localized Doppler spectra of the jets, we studied an in vitro model of steady flow-through stenoses of 86, 96, and 99% area reduction. As fluids, water and a 40% glycerol solution in water were used. MRI was performed with a 1.5 T whole body imager and gradient echo images were obtained in planes parallel to the direction of flow. Doppler spectra were acquired separately from the MR measurements at 1 cm intervals for a distance of 10 cm downstream from the stenosis. Poststenotic signal void was observed for water and for the 40% glycerol solution only if the mean velocity within the stenosis exceeded a limit of 50–60 cm/sec. On the MR images, the jets could be divided into two segments: A proximal jet segment of uniform width equal to the diameter of the stenosis, followed by a distal jet segment which was characterized by broadening and then dissipating signal void. Except for the 99% stenosis, a high signal intensity core was present within the proximal jet segment. In the proximal jet segment, the Doppler measurements showed a low temporal fluctuation of the maximal flow velocity and only little flow opposite to the main flow direction. In the distal jet segment, the velocity fluctuation and the intensity of reverse flow increased sharply. The high signal intensity core of the jet was associated with a poststenotic zone of constant maximal flow velocity. The results demonstrate a close relationship between characteristic features of poststenotic jets in MRI and pulsed Doppler sonography.     

Helical modes in low- and high-swirl jets measured by tomographic PIV

We report on a parallel study on properties of large-scale vortical structures in low- and high-swirl turbulent jets by means of the time-resolved tomographic particle image velocimetry technique. The high-swirl jet flow is featured by a well-established bubble-type vortex breakdown with a central recirculation zone. In the low-swirl flow, the mean axial velocity, while intermittently acquiring negative values, remains positive in the mean but with a local velocity defect immediately downstream from the nozzle exit, followed by a spiralling vortex core system and its eventual breakdown. Measurements of the 3D velocity fields allowed direct analysis of the azimuthal/helical modes via Fourier transform over the azimuthal angle and proper orthogonal decomposition (POD) analysis in the Fourier space. A precessing vortex core is detected for both swirl cases, whereas the POD analysis showed that the one originating in the bubble-type vortex breakdown is much more energetic and easier to detect.     

MR angiography with pulsatile flow.

To achieve acceptable scan times, current multiple thin slice and 3D MR angiography (MRA) methods usually are based on continuous data acquisition, without ECG-synchronization. The purpose of this work is to study consequences of pulsatile blood flow for the 2D inflow method. Arterial blood flow and blood signal intensity versus cardiac phase were studied by a 2D phase based method with retrospective cardiac synchronization. Such studies were performed in different parts of the body and with different excitation flip angles. As expected, a clear relation between intensity enhancement and time dependent flow can be demonstrated. The raw data of these multiphase studies was used to simulate alternative inflow MRA data acquisition strategies to improve image quality, without the excessive increase in scan time implied by standard cardiac triggering. The alternatives investigated were data collection during part of the cardiac cycle and cardiac-ordered phase encoding. Simulation results indicate that the best results are obtained by a combination of both strategies. This method was implemented on Philips Gyroscan systems to compare it with standard nontriggered 2D inflow in practical MRA studies. For highly pulsatile flow, much better MR angiograms were obtained in this way.     

Highly accelerated aortic 4D flow MR imaging with variable-density random undersampling

Purpose

To investigate an effective time-resolved variable-density random undersampling scheme combined with an efficient parallel image reconstruction method for highly accelerated aortic 4D flow MR imaging with high reconstruction accuracy.

Materials and Methods

Variable-density Poisson-disk sampling (vPDS) was applied in both the phase-slice encoding plane and the temporal domain to accelerate the time-resolved 3D Cartesian acquisition of flow imaging. In order to generate an improved initial solution for the iterative self-consistent parallel imaging method (SPIRiT), a sample-selective view sharing reconstruction for time-resolved random undersampling (STIRRUP) was introduced. The performance of different undersampling and image reconstruction schemes were evaluated by retrospectively applying those to fully sampled data sets obtained from three healthy subjects and a flow phantom.

Results

Undersampling pattern based on the combination of time-resolved vPDS, the temporal sharing scheme STIRRUP, and parallel imaging SPIRiT, were able to achieve 6-fold accelerated 4D flow MRI with high accuracy using a small number of coils (N = 5). The normalized root mean square error between aorta flow waveforms obtained with the acceleration method and the fully sampled data in three healthy subjects was 0.04 ± 0.02, and the difference in peak-systolic mean velocity was − 0.29 ± 2.56 cm/s.

Conclusion

Qualitative and quantitative evaluation of our preliminary results demonstrate that time-resolved variable-density random sampling is efficient for highly accelerating 4D flow imaging while maintaining image reconstruction accuracy.     

In vitro experiments on ICOSA6 4D flow MRI measurement for the quantification of velocity and turbulence parameters

PurposeTo perform comprehensive in vitro experiments using six-directional icosahedral flow encoding (ICOSA6) 4D flow magnetic resonance imaging (MRI) under various scan conditions to analyze the robustness of velocity and turbulence quantification.Materials and methodsIn vitro flow phantoms with steady flow rates of 10 and 20 L/min were scanned using both conventional 4D flow MRI and ICOSA6. Experiments focused on comparisons between ICOSA6 and conventional four point (4P) methods, and the effects of contrast agents, velocity encoding range (Venc), and scan direction on velocity and turbulence quantification.ResultsThe results demonstrated that 1) ICOSA6 improves the velocity-to-noise ratio (VNR) of velocity estimation by 33% (on average) and results in similar turbulent kinetic energy (TKE) estimation as the 4P method. 2) Measurements with a contrast agent resulted in more than a 2.5 fold increase in average VNR. However, the improvement of total TKE quantification was not obvious. 3) TKE estimation was less affected by Venc and the scan direction, whereas turbulence production (TP) estimation was largely affected by these measurement conditions. The effects of Venc and scan direction accounted for less than 11.63% of TKE estimation, but up to 33.89% of TP estimation.ConclusionThe ICOSA6 scheme is compatible with conventional 4D flow MRI for velocity and TKE measurement. Contrast agents are effective at increasing VNR, but not signal-to-noise ratio for TKE quantification. The effects of Venc and scan direction influence total TP more than total TKE.     

High sampling-rate measurement of turbulence velocity fluctuations in Mach 1.8 Laval jet using interferometric Rayleigh scattering

Interferometric Rayleigh scattering diagnostic technique for the time-resolved measurement of flow velocity is studied. Theoretically, this systematic velocity-measured accuracy can reach up to 1.23 m/s. Measurement accuracy is then evaluated by comparing with hot wire anemometry results. Moreover, the distributions of velocity and turbulence intensity in a supersonic free jet from a Laval nozzle with a Mach number of 1.8 are also obtained quantitatively. The sampling rate in this measurement is determined to be approximately 10 k Hz.     

Electrocardiograph-triggered two-dimensional time-of-flight versus optimized contrast-enhanced three-dimensional MR angiography of the peripheral arteries

We determined whether the accuracy of magnetic resonance angiography (MRA) in the peripheral run-off vessels can be improved by using contrast-enhanced (CE) three-dimensional (3D) technique in comparison to electrocardiograph (ECG)-triggered two-dimensional (2D) time-of-flight (TOF) technique. In a prospective study 20 patients with occlusions of the pelvic and/or femoral arteries underwent a CE 3D MRA (repetition time (TR): 5 ms, (TE) echo time: 2 ms, flip angle (FA): 30°) and an ECG-triggered 2D time-of-flight (TOF) technique (TR: 408 resp. 608 ms, TE: 7 ms, FA: 70°) of the run-off vessels on a 1.5 T MR system. Each patient received a contrast material volume of 0.15 mmol/kg of body weight of gadolinium (Gd)/DTPA using an automatic injector. The tube system to the patient was flushed by 50 mL of a saline solution applied with the same injection rate as the contrast material administration. The start of the 3D MR sequence was tailored individually to the applied contrast material after determination of circulation times by a prior bolus. All patients underwent each conventional or digital arteriography for comparison, as well. The visualization of the run-off vessels was ranked on a scale of 0–3 (0 = poor, 1 = fair, 2 = good, 3 = excellent) by three blinded reviewers. They also graded the vascular segments as either occluded or significantly altered (>50% reduction in diameter) or free of significant stenosis. CE 3D MRA was significantly faster in imaging the run-off vessels in comparison to the ECG-triggered 2D TOF technique. All 160 vascular segments were visualized with the 3D method, whereas only 142/160 segments were seen with 2D technique. The resulting image quality ranking of all vascular segments was significantly higher (p < 0.05) using CE 3D MRA (2.8) than with the 2D TOF technique (2.4). The detection of the stenoses was possible with both techniques. The grading of seven of seven stenoses was correct with 3D method and in five of seven cases with the 2D TOF technique. All vessel occlusions were detected by using both techniques. Small collaterals were visualized in more detail with the CE 3D MR angiography. These data demonstrate an improvement in image quality and accuracy of MRA of the peripheral arteries using a CE 3D technique in comparison to an ECG-triggered 2D TOF sequence.     

Flow visualization in arteriovenous fistula and aneurysm using computational fluid dynamics

The arteriovenous fistula (AVF) is characterized by enhanced blood flow and is the most widely used vascular access for chronic haemodialysis (Sivanesan et al., 1998). A large proportion of the AVF late failures are related to local haemodynamics (Sivanesan et al., 1999a). As in AVF, blood flow dynamics plays an important role in growth, rupture, and surgical treatment of aneurysm. Several techniques have been used to study the flow patterns in simplified models of vascular anastomose and aneurysm. In the present investigation, Computational Fluid Dynamics (CFD) is used to analyze the flow patterns in AVF and aneurysm through the velocity waveform obtained from experimental surgeries in dogs (Galego et al., 2000), as well as intra-operative blood flow recordings of patients with radiocephalic AVF (Sivanesan et al., 1999b) and physiological pulses (Aires, 1991), respectively. The flow patterns in AVF for dog and patient surgeries data are qualitatively similar. Perturbation, recirculation and separation zones appeared during cardiac cycle, and these were intensified in the diastole phase for the AVF and aneurysm models. The values of wall shear stress presented in this investigation of AVF and aneurysm models oscillated in the range that can both cause damage to endothelial cells and develop atherosclerosis.