Hemodynamic Interpretation of Various Extraanatomical Bypasses: Clinical & Engineering Views

Axillo-bifemoral (Ax-Fem) bypass are now well accepted for bilateral iliac artery occlusion as the second best option. This extra-anatomical (unnatural) bypasses, however, have various hemodynamic liabilities affecting the patency. Hemodynamic conditions of each different type of Ax-Fem bypass were assessed with computer simulation model to determine the hemodynamically more sound type. Simulation models of five different types of Ax-Fem bypass were constructed. Our investigation based on the computer simulation models have shown distinct differences between two most popular Lazy-S type and Inverted-C type on the distribution of flow volume, shear stress and recirculation zone, etc., though both types have shown similar clinical results. Lazy-S type has shown better hemodyanmic status than inverted-C type. The theoretical advantage of "Lazy-S" type has never been adequately proved for its superiority clinically over the inverted-C type. Inverted-C type is now in more favor with clinically better results in spite of many hemodynamic liabilities including retrograde flow to the branching graft. The improvement of over-all long-term patency rate of various extra-anatomical bypasses is still warranted through proper correction of the hemodynamic liability. Even though clinical outcome of the extra-anatomical bypass has been equal regardless of the type of crossover femoral graft configuration, there are distinct differences on the hemodynamic characteristics among various types of configuration. Further hemodynamic study in the pulsatile flow status is warranted to correct hemodynamic defects with proper modification of various hemodynamic factors of each model.