Purpose Peripheral arteriovenous malformations (pAVMs) are congenital lesions characterised by abnormal high-flow, low-resistance vascular connections-the so-called nidus-between arteries and veins. The mainstay treatment typically involves the embolisation of the nidus, however the complexity of pAVMs often leads to uncertain outcomes. This study aims at developing a simple, yet effective computational framework to aid the clinical decision making around the treatment of pAVMs using routinely acquired clinical data. Methods A computational model was developed to simulate the pre-, intra-, and post-intervention haemodynamics of a patient-specific pAVM. A porous medium of varying permeability was employed to simulate the sclerosant effect on the nidus haemodynamics. Results were compared against clinical data (digital subtraction angiography, DSA, images) and experimental flow-visualization results in a 3D-printed phantom of the same pAVM. Results The computational model allowed the simulation of the pAVM haemodynamics and the sclerotherapy-induced changes at different interventional stages. The predicted inlet flow rates closely matched the DSA-derived data, although the post-intervention one was overestimated, probably due to vascular system adaptations not accounted for numerically. The nidus embolization was successfully captured by varying the nidus permeability and increasing its hydraulic resistance from 0.330 to 3970 mmHg s ml(-1). The nidus flow rate decreased from 71 of the inlet flow rate pre-intervention to 1: the flow completely bypassed the nidus post-intervention confirming the success of the procedure. Conclusion The study demonstrates that the haemodynamic effects of the embolisation procedure can be simulated from routinely acquired clinical data via a porous medium with varying permeability as evidenced by the good qualitative agreement between numerical predictions and both in vivo and in vitro data. It provides a fundamental building block towards a computational treatment-planning framework for AVM embolisation.
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机译：目的 外周动静脉畸形 （pAVM） 是先天性病变，其特征是动脉和静脉之间的异常高流量、低阻力血管连接（即所谓的病灶）。主要治疗通常涉及病灶栓塞，但 pAVM 的复杂性通常会导致不确定的结果。本研究旨在开发一个简单而有效的计算框架，以帮助使用常规获取的临床数据围绕 pAVM 治疗做出临床决策。方法 建立计算模型，模拟患者特异性pAVM干预前、干预中和干预后的血流动力学。采用不同渗透率的多孔介质来模拟硬化剂对病灶血流动力学的影响。将结果与临床数据（数字减影血管造影、DSA、图像）和相同 pAVM 的 3D 打印模型中的实验血流可视化结果进行比较。结果 计算模型可以模拟不同介入阶段pAVM血流动力学和硬化疗法诱导的变化。预测的入口流速与DSA得出的数据非常吻合，尽管干预后的数据被高估了，这可能是由于血管系统适应没有用数字来解释。通过改变病灶渗透率并将其水力阻力从0.330 mmHg s ml（-1）增加到3970 mmHg s ml（-1），成功捕获了病灶栓塞。病灶流速从干预前入口流速的 71% 下降到 1%：流量完全绕过干预后的病灶，证实了手术的成功。结论 研究表明，栓塞手术的血流动力学效应可以通过具有不同渗透率的多孔介质从常规获得的临床数据中模拟，数值预测与体内和体外数据之间的良好定性一致性证明了这一点。它为动静脉畸形栓塞的计算治疗计划框架提供了基本的构建块。
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