RESEARCH ARTICLE | JULY 10 2024

Comparative analysis of mechanical wall shear stress and

hemodynamics to study the influence of asymmetry in
abdominal aortic aneurysm and descending thoracic aortic
aneurysm 
M. Abaid Ur Rehman  ; Özgür Ekici

Physics of Fluids 36, 071904 (2024)

https://doi.org/10.1063/5.0216980

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Comparative analysis of mechanical wall shear

stress and hemodynamics to study the influence
of asymmetry in abdominal aortic aneurysm
and descending thoracic aortic aneurysm
Cite as: Phys. Fluids 36, 071904 (2024); doi: 10.1063/5.0216980
Submitted: 2 May 2024 . Accepted: 19 June 2024 .
Published Online: 10 July 2024

M. Abaid Ur Rehman1,2,a) € u
and Ozg € r Ekici2,b)

AFFILIATIONS
1
Department of Mathematics, School of Natural Sciences (SNS), National University of Sciences and Technology (NUST),
Sector H-12, 44000 Islamabad, Pakistan
2
Department of Mechanical Engineering, Hacettepe University, 06800 Beytepe, Ankara, Turkey

a)
Author to whom correspondence should be addressed: [email protected]
and [email protected]
b)
Electronic mail: [email protected]

19 July 2024 08:32:38

ABSTRACT
An aneurysm’s rupture is commonly associated with its maximum diameter, yet biomechanical studies emphasize the significant influence of
mechanical wall shear stress (WSS) in this process. This study focuses on two models of aortic aneurysms: abdominal aortic aneurysm and
descending thoracic aortic aneurysm. Five cases, comprising two for model 1 and three for model 2, are examined to explore both
axisymmetric and asymmetric shapes, as patient geometry may manifest as either fusiform (axisymmetric) or saccular (asymmetric), while
maintaining a consistent aneurysm diameter and adjusting the bulge shape factor to induce asymmetry. Hemodynamic factors, including
WSS and wall shear stress gradient, are computed to evaluate thrombus formation and rupture risk within the aneurysms. Our results
indicate the presence of recirculation zones in both the medial and transverse planes, generating vortices within the aneurysm. These vortices
are more prominent in asymmetric cases compared to axisymmetric cases, leading to increased blood residence time within the aneurysm
and a higher likelihood of thrombus formation. Thrombus formation can further impede blood flow, heightening the risk of embolism or
ischemic events. Rupture occurs when the WSS surpasses tissue strength; thus, if the tissue strength of all aneurysms is same, our findings
suggest that rupture risk varies according to asymmetry. In the transverse direction, our results demonstrate that in model 1, case 1 exhibits
uniform WSS on both sides, while in case 2, WSS is higher at the posterior sides of the aneurysm sac. Conversely, in model 2, WSS is higher
at the anterior side of the aneurysm. In the medial direction of the aneurysm, WSS is highest for case 5, followed by case 3, case 4, case 2, and
case 1, respectively, indicating elevated WSS when the anterior bulge dominates over the posterior bulge for each model. Overall, a higher
rupture risk is observed in model 2 compared to model 1 due to increased mechanical stresses.
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I. INTRODUCTION in population age distribution over time. An analysis of particular risk

A significant increase in 81.6% in the number of deaths linked to variables associated with aneurysm-related mortality revealed that
aortic aneurysms (AAs), from 94 968 in 1990 to 172 427 in 2019. This smoking contributed less to deaths in 2019 to 34.6% vs 45.6% in 1990.
increase was far faster than the 18.2% rise in general mortality that was Similarly, the proportion of deaths linked to hypertension dropped
noted in the same period. An examination of age-specific mortality from 38.7% to 34.7%. Interestingly, more often than smoking, hyper-
trends showed a strong correlation between the incidence of deaths tension is now the leading risk factor for the death from aortic aneur-
from aortic aneurysms and increasing age.1 On the other hand, age- ysms globally.2 Over an average lifetime, the aorta, the biggest artery
standardized death rates decreased by 18% between 1990 and 2019, conduit in the human body, pumps 200
106 l of blood. This impor-
from 2.72 per 100 000 to 2.21 per 100 000, taking into account changes tant blood artery can develop aneurysms due to a variety of inherited

Phys. Fluids 36, 071904 (2024); doi: 10.1063/5.0216980 36, 071904-1

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and acquired disorders that change flow patterns and wall stress. such as curvature radius, bend angle, and distance between two bends.
Depending upon whether the thoracic or abdominal section of the Additionally, they measured hemodynamic descriptors such as WSS,
aorta undergoes this pathological dilatation, these diseases present as wall shear stress gradient (WSSG), and oscillatory shear index to assess
either thoracic aortic aneurysms (TAAs) or abdominal aortic aneur- the propensity for atherosclerosis development. Their findings indi-
ysms (AAAs).3,31 cated that arterial wall regions characterized by high relative residence
In the context of AAs, it is essential to determine at what point in time, high time-averaged wall shear stress gradient, low oscillatory
the aneurysm’s natural progression the risk of rupture warrants the shear index, and high endothelial cell activation potential were more
procedure, despite potential complications. The decision to elective prone to plaque progression and rupture. Nagargoje et al.11 examined
repair an aortic aneurysm (AA) is often determined by its maximum the internal carotid artery (ICA) siphon in a variety of ICA bifurcation
diameter. Various anatomical factors have also been proposed as aneurysm models with C-, U-, S-, and helical-shaped bends to explore
potential predictors of aneurysm severity.4,28 These standards lack pre- the initiation, development, and rupture of aneurysms, revealing that
cision and exclude certain important information about particular various characteristics of the parent arterial, including its shape, tortu-
aneurysm attributes. For example, AAs of the same maximum diame- osity, curvature, and number of turns, influence the attendant hemo-
ter might vary in terms of shape, wall thickness, or mechanical proper- dynamics. Furthermore, Qiu et al.12 explored the hemodynamics of
ties, influencing their likelihood of growth and rupture. Therefore, a patient-specific abdominal aortic aneurysms with iliac artery tortuos-
surgery based on a critical diameter of 5 cm or other similar criteria ity, revealing that the wall shear stress (WSS) in tortuous aortas is three
may be unjustifiable because of low rupture risk, or it should be con- times higher than in normal aortas, and Li et al.13 investigated
sidered earlier because rupture may occur at a diameter of less than descending aorta models with varying degrees of tortuosity, assessing
5 cm.5,6 Since rupture occurs when the mechanical stress exceeds the hemodynamic parameters. Furthermore, Klis et al.14 used computa-
tissue’s tensile strength, risk assessment based on wall shear stress tional fluid dynamics to study the impact of tortuosity on hemody-
(WSS) and hemodynamic factors provides a more accurate prediction namics related to cerebral aneurysms utilizing basilar artery models.
of rupture likelihood.20,30 To evaluate the rupture risk of AAs compre- The many types of aneurysms include fusiform aneurysms, which
hensively, Mutlu et al.8 conducted a study examining Newtonian and progressively enlarge, encompassing the entire circumference of the
pulsatile flow dynamics, aiming to elucidate how hemodynamic varia- artery or axisymmetric, and saccular aneurysms or asymmetric, which
bles are disrupted in AAA. Large, unruptured aneurysms are usually are isolated balloon-like enlargement only a portion of artery wall.
repaired by open surgery by a vascular surgeon. An incision from the There is no clear correlation between these forms and any particular

19 July 2024 08:32:38

top of the pubic bone to the area immediately below the breastbone cardiovascular disease or set of symptoms. Moreover, medium- to
must be made for this. After that, the aneurysm is opened, the aorta is large-sized aneurysms could be fusiform structures. AAs become
severed, and a graft that will function as a blood vessel is placed. The asymmetrical due to surrounding tissue and the vertebral column,
weakened aorta wall is protected from the direct pulsing pressure of leading to less fusiform expansion and to grow apart from lumens cen-
the blood by the plastic graft, which redirects blood flow and essen- terline, causing significant anterior dilation with a flatter posterior sur-
tially stops future expansion.17 face.29 Belkacemi et al.6 explored the relationship between
The blood flow in aneurysm sacs is not smooth and exhibits low hemodynamics and wall shear stress (WSS) using a variety of symmet-
wall shear stress and oscillating patterns, unlike regular aortas, which ric and asymmetric aneurysm models. Their findings revealed higher
have high wall shear stress flow. Thrombus formation in AAs is closely WSS levels in proximal areas compared to within the aneurysm sacs,
associated with areas of low WSS,25,38 often caused by changes in flow with increased vortex formation observed in asymmetric cases com-
patterns. Belkacemi et al.6 employed both symmetric and asymmetric pared to axisymmetric ones, potentially contributing to thrombus for-
aneurysm models to explore the relationship between hemodynamics mation. Additionally, Vorp et al.30 investigated two types of
and WSS. They observed increased vortex generation in asymmetric asymmetric models, focusing on maximum aneurysm diameter and
cases compared to axisymmetric ones, potentially contributing to different levels of asymmetry to analyze WSS. Their conclusion
thrombus formation. Additionally, thrombus formation is frequently emphasized that aneurysm rupture is not solely determined by maxi-
observed in recirculating zones within abdominal aneurysms.36,37 mum diameter or symmetry but rather by the mechanical stress within
Razzaq26 investigated flow behavior in bifurcated arteries and found the aneurysmal wall surpassing the tissue’s tensile strength, which can
low velocity and vortices near plaque formation sites, which he sug- be evaluated through mechanical WSS. T€ urk40 investigated AAA and
gested contribute to thrombus formation. This altered flow is believed hemodynamic predictors, such as WSS and WSSG. The author find-
to induce inflammation in endothelial cells, leading to thrombus for- ings revealed that WSSG is negative toward the proximal end and
mation, weakening, and degeneration of the artery wall, ultimately within the aneurysm sacs, indicating the presence of vortices, while it
resulting in aneurysm rupture and potential embolism or ischemic becomes positive. The peak of WSSG is observed toward the distal
events.7 neck of the aneurysm, signifying the highest hemodynamic
Arterial tortuosity, characterized by deviations from a straight abnormality.
path, holds significant importance in influencing hemodynamics and In this study, we examined the hemodynamics factors and WSS
vascular health, with its impact essential for understanding various car- of two types of aortic aneurysms: abdominal aortic aneurysm (AAA)
diovascular conditions. Utilizing computational fluid dynamics (CFD), and descending thoracic aortic aneurysm (DTAA). Previous studies by
recent computational studies have investigated how tortuosity affects Belkacemi et al.6 and Vorp et al.30 focused on AAA models, comparing
artery health. Ebrahim and Fallah9 delved into the impact of bending asymmetry and axisymmetric studies. In contrast, our study specifi-
tortuosity on plaque stresses, while Buradi and Mahalingam10 intro- cally compares the results of AAA and DTAA. We explored the effects
duced idealized models of tortuous arteries, considering parameters of both axisymmetric and asymmetric shapes on various aspects,

Phys. Fluids 36, 071904 (2024); doi: 10.1063/5.0216980 36, 071904-2

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including flow behavior and key hemodynamic factors such as WSS is 20 cm. Figure 1(a) showcases the three-dimensional view of model 1,
and WSSG, which play pivotal roles in thrombus formation and evalu- and Fig. 1(c) offers insight into cross-sectional area of the aneurysm
ating rupture risk. Our analysis encompassed five distinct cases, sacs.
including two for AAA and three for DTAA. To the best of our knowl- The asymmetry ratio, denoted as b, is defined as b ¼ r=R, where
edge, this research represents the first comprehensive investigation R represents the anterior wall dimension, r represents the posterior
into the influence of axisymmetric and asymmetric aneurysm shapes wall dimension, and r þ R denotes the maximum diameter. In model 1,
on WSS, WSSG, and hemodynamics for both AAA and DTAA. b ¼ 1 indicates an axisymmetric AAA, where r ¼ R. Conversely,
b ¼ 0:48 suggests a scenario where the bulging of the anterior wall
II. MATERIAL AND METHODS surpasses that of the posterior wall.
A. Geometric description
In the analyzed configurations, we investigated two models of 2. Descending thoracic aortic aneurysm (DTAA)
aortic aneurysms (AAs): model 1, representing abdominal aortic aneu-
Model 2 depicts the descending thoracic aortic aneurysm
rysm (AAA), and model 2, depicting descending thoracic aortic aneu-
(DTAA) and was examined with three cases. In this model, the inlet
rysm (DTAA). Model 1 was explored in detail with two distinct cases,
and outlet have a diameter of 2 cm, and the diameter of the aneurysm
while model 2 was examined with three cases. Figure 1 provides a
is 4 cm, with a bend radius of 2 cm. The length of the aneurysm seg-
visual representation of these models. Figures 1(a) and 1(b) showcase
ment is 5 cm, and the total length of the artery is 17.5 cm. Additionally,
the three-dimensional (3D) view of model 1 for cases 1 and 2, respec-
the radius for the bend section is 1.5 cm.
tively, while Figs. 1(c)–1(e) present the three-dimensional perspective Figure 1(b) presents the three-dimensional perspective of model
of model 2 for cases 1–3, respectively. Additionally, Fig. 1(f) offers 2, and Fig. 1(c) provides insight into the cross-sectional area of the
insight into the cross-sectional area of the aneurysm sac. These models aneurysm sacs. The asymmetry ratio, b, is defined as b ¼ r=R, where
were generated using ANSYS DesignModeler. b ¼ 1 represents an axisymmetric descending aortic aneurysm for
In our study, we incorporated at least two planes of symmetry: one case, b ¼ 2:08 indicates a posterior wall bulge dominance, and
the transverse plane (xz plane) and the medial plane (xy plane). Our b ¼ 0:48 denotes an anterior wall bulge dominance. In both models,
models exhibit axisymmetry concerning the transverse plane, while the maximum diameter are kept constant at 4 cm while an asymmetry
asymmetry varies concerning the medial plane. parameter b was varied.

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1. Abdominal aortic aneurysm (AAA) B. Governing equations and numerical modeling
Model 1 represents the AAA and was explored in detail with two Blood, composed of cells suspended in plasma, demonstrates
distinct cases. In this model, the inlet and outlet have a diameter of non-Newtonian behavior, particularly notable in vessels with diame-
2 cm, while the maximum diameter of the aneurysm is 4 cm. The ters smaller than 1 mm.33 In certain pathological and transient condi-
length of the aneurysm body is 5 cm, and the total length of the artery tions, such as artery dilatation and bifurcations, shear rates may

FIG. 1. Visual representations of aortic aneurysm models. (a) Three-dimensional depiction of model 1 (case 1), (b) three-dimensional illustration of model 1 (case 2), (c) three-
dimensional presentation of model 2 (case 3), (d) three-dimensional representation of model 2 (case 4), (e) three-dimensional perspective of model 2 (case 5), and (f) cross-
sectional area of the aneurysm sac.

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decrease below 100 s1 ,23 underscoring the potential importance of Additionally, we compared the results for Newtonian and Casson
non-Newtonian processes.21,24,27 Conversely, in larger capillaries fluid model. Our findings indicate that although there are slight differ-
where shear rates typically exceed 100 s1 23 and with diameters ences in magnitudes, the overall trends including the presence of recir-
exceeding 0.3 mm, blood can be accurately represented as a culation zones and the distribution of wall shear stress (WSS) values,
Newtonian fluid.15,18,19,22,34 with higher values proximally and lower values at the aneurysm sac

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FIG. 2. Grid independence study. (a) WSS of the medial plane on the anterior wall of case 2, (b) WSS of the medial plane on the posterior wall of case 2, (c) WSS of the trans-
verse plane of case 2, (d) WSS of the medial plane on the anterior wall of case 3, (e) WSS of the medial plane on the posterior wall of case 3, and (f) WSS of the transverse
plane of case 3.

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TABLE I. Aortic aneurysm models. Model 1 indicates abdominal aortic aneurysm. Lei et al.39 introduced the wall shear stress gradient (WSSG) as a
Model 2 indicates descending thoracic aortic aneurysm. hemodynamic indicator, which measures spatial variations in surface
forces per unit area. The WSSG value is determined using the central
Aortic aneurysm Cases r ðcmÞ R ðcmÞ b ¼ r=R differencing approach, as stated in the following formula:40
Model 1 Case 1 2 2 1 @sw sw ðxi þ DxÞ  sw ðxi  DxÞ
Case 2 1.3 2.7 0.48 WSSG ¼ ¼ : (4)
@x x¼xi 2Dx
Model 2 Case 3 2 2 1
Case 4 2.7 1.3 2.08
Case 5 1.3 2.7 0.48 C. CFD simulation
The governing equations are solved utilizing the ANSYS Fluent
commercial solver, which employs the finite volume method. Within
remain consistent across both models. Based on this comparison, a this framework, the pressure-based solver is employed to sequentially
Newtonian fluid model was selected due to its practicality and rele- tackle the non-linear mass and momentum conservation equations.
vance in modeling arterial blood flow. This model incorporates a rigid To facilitate pressure–velocity coupling, the COUPLED scheme is
artery wall and takes into account blood density of 1050 kg/m3 and vis- implemented. Discretization of these equations is achieved through a
cosity of 0.0035 Pa s.16 Consequently, the incompressible Navier– second-order upwind differencing scheme. Additionally, to ensure
Stokes equations were employed to effectively characterize the flow accurate convergence, a residual error convergence threshold of 105
behavior:6 is set.
~ ~ The grid independence study was conducted for two models
r v ¼ 0; (1) using the Ansys Fluent software. Specifically, we solved two cases, case
qð~ ~
v  rÞ~ ~ þ lr2~
v ¼ rp v; (2) 2 (axisymmetric) and case 3 (asymmetric), to evaluate the wall shear
stress (WSS) values. The results of this study are illustrated in Fig. 2.
where q denotes density and l represents dynamic viscosity. For axisymmetric cases, various cell sizes were tested with an element
A fully developed parabolic laminar flow32 was prescribed at the
size of 0.001 m, progressing to finer meshes with a cell size of
inlet, with an average velocity of 0.066 667 m/s, or 400 Reynolds num-
0.0003 m. For asymmetric, the cell sizes ranged from 0.005 to
ber, and at outlet free pressure boundary condition.

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0.0005 m. For axisymmetric cases, we utilized sweep cells, whereas for
In simulations, for simplicity, arterial walls are often considered
asymmetric cases in model 2, we employed tetrahedral cells. The opti-
rigid while determining WSS.35 When dealing with elderly individuals
mum mesh size 0.0003 m was selected for axisymmetric cases and
who have increased vascular stiffness, wall motion usually has a negli-
0.0005 m for asymmetric cases. It was selected if the peak wall shear
gible impact on velocity and WSS fields. Therefore, the vessel walls
stress does not increase by more than 2%.
were taken to be rigid and the no-slip condition was imposed. The fol-
lowing provides the WSS formula: III. RESULTS AND DISCUSSION
@u Two three-dimensional models were employed to investigate the
s¼l ; (3) impact of varying the parameter b (asymmetry) in AAs. The asymme-
@y
try of the aneurysm pertains to the medial plane, while with respect to
where s represents WSS, l is dynamic viscosity, and @u
@y represents the the transverse plane, all cases are axisymmetric. Model 1 represents
velocity gradient perpendicular to the vessel wall. AAA, while model 2 represents DTAA. Model 1 consists of two cases,

FIG. 3. Normalized velocities across the center of the aneurysm. (a) Comparison of the x-velocities and (b) comparison of the y-velocities. u0 indicates the centerline velocity at
the proximal end of the entrance tube.

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whereas model 2 comprises three cases. Detailed information regard- aneurysm range from 10 to 40 times higher than the maximum veloci-
ing these cases is provided in Table I, with a three-dimensional view ties observed in the recirculation zones, a trend consistent across cases
depicted in Fig. 1. 1–5. Similarly, Fig. 3(b) indicates that y-velocities at the center of the
Figure 3 presents the normalized velocities for all five cases at the aneurysm are 2–40 times higher than the maximum velocities in the
center of the aneurysm. Specifically, Fig. 3(a) depicts the x-velocities at recirculation zones, varying across cases 1–5. Notably, negative veloci-
the center of the aneurysm, while Fig. 3(b) illustrates the y-velocities. ties observed in Fig. 3(a) signify the presence of recirculation zones.
Analysis of Fig. 3(a) reveals that the x-velocities at the centerline of the Similarly, Fig. 3(b) exhibits negative velocities at certain points,

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FIG. 4. Velocity streamlines of medial planes. (a)–(e) The streamlines of case 1–case 5, respectively. The legend values indicate the normalized velocity.

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indicating the presence of recirculation zones in those areas as well. blood flows through the aneurysm, surrounded by recirculation zones,
These observations suggest the existence of recirculation zones in both with the center of recirculation toward the distal neck of the aneurysm.
transverse and medial directions, indicative of secondary flow patterns Notably, Figs. 4(c)–4(e) demonstrate the absence of recirculation zones
within the aneurysm. on the posterior side of the medial planes of the aneurysm. However,
Figures 4(a)–4(e) display the streamlines of medial planes for in Figs. 5(c)–5(e), clear recirculation zones are visible on both the pos-
cases 1–5, respectively, while Figs. 5(a)–5(e) present the streamlines for terior and anterior sides of the transverse planes of the aneurysm, indi-
transverse planes for cases 1–5, respectively. The results reveal that the cating the presence of secondary flow patterns and vortices within the

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FIG. 5. Velocity streamlines of transverse planes. (a)–(e) The streamlines of case 1–case 5, respectively. The legend values indicate the normalized velocity.

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aneurysm. Additionally, from Fig. 5, it is evident that the aneurysm is to the transverse planes, the WSS for both the anterior and posterior
axisymmetric in the transverse direction. These secondary flow pat- sides of the transverse plane is identical. The figures reveal that the
terns have the potential to promote the formation of stagnant or slow- WSS is highest at the proximal neck of the aneurysm, sharply decreas-
moving regions within the aneurysm, thereby increasing the resistance ing to zero at approximately x=d  0:7 (varying for all cases). From
time of blood within the aneurysm and elevating the risk of thrombus x=d  0:2 to  2:1 (also varying), the WSS remains negative, indicat-
(blood clot) formation. In cases of asymmetry, where the bulge is more ing the presence of recirculation zones where flow moves in the nega-
pronounced than in axisymmetric cases, the presence of vortices is tive x direction. Subsequently, at approximately x=d ¼ 2:1 (varies for
more pronounced, potentially exacerbating the risk of thrombus for- all cases), the WSS abruptly increases, reaching its peak value at the
mation. Thrombus formation can further obstruct blood flow, increas- distal neck of the aneurysm. At this juncture, both the core flow and
ing the risk of embolism or ischemic events, and may also contribute the recirculating flow reconverge, marking the onset of a new bound-
to aneurysm rupture.37 ary layer development for each flow.32 This is accompanied by a nota-
Figure 6 illustrates the two-dimensional graphics of WSS on both ble rise and fall in the amplitude of wall shear stress, a consistent
the medial and transverse planes, normalized by the Poiseuille flow behavior observed across all three planes. In Fig. 6(a), it is evident that
wall shear stress. In Fig. 6(a), the WSS is depicted on the anterior wall the negative peak of WSS is significantly high for asymmetric cases
of the medial plane for all five cases, while Fig. 6(b) shows the WSS on compared to axisymmetric cases toward the distal end of the aneu-
the posterior wall of the medial plane. Figure 6(c) presents the WSS on rysm, across both model 1 and model 2. This suggests a greater preva-
the transverse plane. Since all five cases are axisymmetric with respect lence of recirculation zones in asymmetric cases, particularly toward

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FIG. 6. Normalized WSS of the medial and transverse planes. (a) x-WSS comparison on the anterior wall of the medial plane, (b) x-WSS on the posterior wall of the medial
plane, and (c) x-WSS of the transverse plane.

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the distal ends. Among the cases, case 5 exhibits the largest recircula- implications for patient risk assessment and management strategies
tion zone area, followed by case 3, case 4, case 2, and, finally, case 1. aimed at reducing the likelihood of thrombus-related complications
Furthermore, Fig. 6(b) illustrates that negative WSS values are more and aneurysm rupture.
pronounced toward the distal neck compared to the proximal end for Figure 7 illustrates the two-dimensional graphics of wall shear
model 1, while in model 2, they are more prominent at the proximal stress gradient (WSSG) on both the medial and transverse planes. The
necks of the aneurysm, confirming the presence of recirculation zones. WSSG exhibits distinct patterns along the length of the vessel. At the
Similarly, in Fig. 6(c), negative WSS values are more prominent toward proximal neck of the aneurysm, WSSG is negative, indicating a conver-
the distal necks of the aneurysm, indicating the occurrence of recircu- gent flow pattern where adjacent regions of the vessel wall experience
lation zones. Thus, it is evident from the discussion above that recircu- decreasing shear stress along the direction of flow. This suggests
lation zones occur in both the medial and transverse planes. The adverse flow conditions, due to the flow separation induced by the
presence of vortices, resulting from recirculation zones, increases the aneurysm. Within the recirculation sacs, WSSG is negative. The
residence time of blood within the aneurysm, thereby elevating the risk WSSG graph lines show an oscillating pattern, characterized by alter-
of thrombus formation.7 Thrombus formation within aneurysms poses nating regions of convergent and divergent shear stress gradients. This
a significant risk of rupture, underscoring the importance of under- signifies complex flow dynamics within the aneurysm sac, with areas
standing and mitigating factors contributing to recirculation zones and of flow recirculation contributing to the observed fluctuations in shear
subsequent thrombus formation. These findings not only enhance our stress gradients. Moving toward the distal neck of the vessel, WSSG
comprehension of aneurysm hemodynamics but also hold critical becomes positive again, indicating a return to more favorable flow

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FIG. 7. Normalized WSSG of the medial and transverse planes (a) WSSG comparison on the anterior wall of the medial plane, (b) WSSG on the posterior wall of the medial
plane, and (c) WSSG of the transverse plane.

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conditions with divergent shear stress gradients along the direction of repair, which assumes that all AAs of the same diameter have the same
flow. However, at the end of the distal neck, WSSG turns negative likelihood of rupture, may not be accurate based on our results.
once more, suggesting adverse flow conditions persisting beyond the Furthermore, Fig. 9 reveals that the WSS is higher at the distal necks of
aneurysm, due to the recombination of aneurysm toward the artery the aneurysm compared to the proximal necks, and the WSS at these
wall. Overall, the observed patterns in WSS and WSSG reveal a com- necks is higher than that at the aneurysm sacs. Moreover, the transi-
plex flow environment characterized by convergent and divergent flow tion from axisymmetric to asymmetric aneurysms, particularly with a
patterns, oscillating shear stress gradients, and adverse flow conditions dominant anterior bulge, generally leads to increased WSS in both
associated with the presence of the aneurysm. These findings provide models. However, in model 2, case 4, where the posterior bulge is dom-
valuable insights into the hemodynamic conditions within and around inant, the WSS is lower compared to other cases. Moreover, upon
the aneurysm, which are crucial in understanding the progression and comparing both sides of the aneurysm in the medial direction for each
potential complications of aneurysms. WSSG provides additional case, it is observed that the WSS is approximately the same. This sug-
information that WSS alone cannot, such as identifying regions with gests that the rupture risk in the medial direction for both sides is
rapidly changing shear stress, which may experience more pronounced approximately equal for each case. However, when considering the
biological responses. For example, areas with high WSSG may be more rupture risk across all cases based on WSS, it is noted that the risk is
prone to endothelial cell activation or dysfunction, leading to further highest for case 5, followed by case 3, case 4, case 2, and case 1 in the
pathological changes in the vessel wall. By analyzing both WSS and medial direction of the aneurysm. Notably, aneurysms with identical
WSSG, a more comprehensive understanding of the hemodynamic diameters may display varying rupture propensities depending on their
forces at play is gained, essential for accurately assessing the risk of asymmetry, underscoring the significance of this information in com-
aneurysm progression and rupture. This combined analysis offers a prehending the natural progression of AAA and in its clinical manage-
more detailed view of the aneurysm’s hemodynamic environment, aid- ment. These findings bear implications for the prediction and
ing in the development of better diagnostic and therapeutic strategies. management of rupture risk in both AAA and DTAA, emphasizing
Aneurysm rupture occurs when mechanical wall stress exceeds the necessity of considering geometric factors in clinical decision-
the tissue’s strength, resulting in severe aortic wall failure. making. Overall, this study contributes to our comprehension of aortic
Understanding the wall stresses in AAs can enhance clinicians’ ability aneurysm pathophysiology and furnishes valuable insights for patient
to predict rupture risk accurately. Our research indicates that aneu- care.
rysm geometry influences stress distribution within the AAs wall and
IV. CLINICAL RELEVANCE AND LIMITATIONS

19 July 2024 08:32:38

may elevate rupture risk. Figures 8 and 9 depict 3D plots of WSS for
transverse and medial directions, respectively. Figures 8(a)–8(e) show Our study investigates the hemodynamics of abdominal and
the anterior side of the aneurysm, while Figs. 8(f)–8(j) show the poste- descending thoracic aneurysm models, incorporating both symmetric
rior side. It is evident that WSS is higher at the proximal and distal and asymmetric geometries to reflect the saccular and fusiform shapes
necks of the anterior side compared to the aneurysm sacs. commonly observed in real patients. By using idealized models, we
Additionally, transitioning from axisymmetric to asymmetric shapes, aim to uncover fundamental flow behaviors that are crucial for under-
particularly in DTAA, increases WSS, with DTAA generally exhibiting standing aneurysm progression and rupture risk.
higher WSS than AAA. On the posterior side, WSS is higher at the dis- The inclusion of both symmetric and asymmetric aneurysm
tal neck compared to the proximal neck, though for model 2, WSS at shapes in our models allows us to simulate the range of anatomical
the posterior end is notably lower than model 1. From our analysis, it variations seen in patients, providing insights into how these variations
is evident that the magnitude of wall shear stress (WSS) in model 2 is influence hemodynamics. Symmetric models help establish baseline
higher than in model 1. In both models, transitioning from axisym- flow characteristics, while asymmetric models capture the more com-
metric to asymmetric aneurysms, where the anterior bulge dominates plex flow patterns associated with real patient anatomies. This dual
over the posterior bulge, generally leads to increased WSS. However, approach enhances the relevance of our findings to clinical scenarios.
this trend reverses in case 4, where the posterior bulge dominates, Our use of a parabolic inlet velocity profile, which is a simplified
resulting in decreased WSS. Overall, for model 2, stresses are higher at representation of blood flow entering the aorta, is particularly signifi-
the distal necks compared to the posterior necks of the aneurysm, with cant. Although this profile represents steady-state flow, it approximates
anterior sides experiencing higher stresses than posterior sides. Since the average flow during the cardiac cycle. Blood flow in the aorta is
tissue strength at the distal and proximal neck is higher than in the inherently pulsatile, characterized by systolic (when the heart pumps
aneurysm sac,30 observations from our study indicate that in case 1, blood) and diastolic (when the heart fills with blood) phases. Though
the wall shear stress (WSS) is uniform on both the anterior and poste- pulsatile flow may change the magnitude of WSS and velocity values,
rior sides of the aneurysm sac, suggesting an equal likelihood of rup- with higher values during the systolic phase and lower during the dia-
ture on both sides. Conversely, in case 2, the WSS is higher on the stolic phase, it does not significantly alter the behavior of hemody-
posterior side of the sac compared to the anterior side, implying a namic factors.
potential rupture site at the posterior surface. For cases 3–5, the WSS is Understanding the fundamental flow patterns, wall shear stress
higher on the anterior side of the aneurysm compared to the posterior (WSS), and wall shear stress gradients (WSSG) within these aneurysms
side, suggesting a potential rupture site on the anterior surface. is critical for assessing clinical risks. For example, areas of high WSS
Additionally, our findings demonstrate that in model 1, the WSS is and fluctuating WSSG are associated with endothelial damage and
higher at the posterior sides of the aneurysm sac, whereas in model 2, potential thrombus formation, which are key factors in aneurysm
the opposite trend is observed. Thus, the critical diameter criterion growth and rupture. These insights can guide clinicians in identifying
that is commonly used for guiding decisions regarding elective AA high-risk patients and tailoring monitoring and intervention strategies.

Phys. Fluids 36, 071904 (2024); doi: 10.1063/5.0216980 36, 071904-10

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19 July 2024 08:32:38

FIG. 8. Normalized WSS contours of the aneurysm in the transverse direction. (a)–(e) The WSS of the anterior side for cases 1–5, respectively, and (f)–(j) the WSS of the pos-
terior side for cases 1–5, respectively.

Despite these advantages, our study has limitations that must be younger patients or those with less advanced vascular disease. The
acknowledged. The use of idealized models means that our simulations exclusion of pulsatile flow conditions, focusing instead on steady-state
do not capture the full complexity of individual patient anatomies. scenarios, limits the study’s ability to mimic the dynamic nature of
Real patient-specific geometries, which can significantly influence blood flow influenced by cardiac cycles. These simplifications, while
aneurysm behavior, are not fully represented by our simplified models. useful for isolating specific hemodynamic phenomena, mean that our
This limitation affects the direct applicability of our findings to indi- results should be interpreted as providing general trends rather than
vidual clinical cases. precise predictions for individual patients.
Furthermore, our models assume rigid aortic walls, which may In conclusion, our study provides valuable insights into the
not accurately represent the elastic properties of arterial walls in hemodynamics of abdominal and descending thoracic aneurysms,

Phys. Fluids 36, 071904 (2024); doi: 10.1063/5.0216980 36, 071904-11

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19 July 2024 08:32:38

FIG. 9. Normalized WSS contours of the aneurysm in the medial direction. (a)–(e) The WSS of the anterior side for cases 1–5, respectively, and (f)–(j) the WSS of the posterior
side for cases 1–5, respectively.

capturing key flow patterns and stress distributions that are critical for approach significantly contributes to the understanding of aneurysm
understanding aneurysm behavior. While our findings offer founda- dynamics, aiding in the development of better diagnostic and thera-
tional knowledge that can guide further research and clinical practice, peutic strategies.
it is essential to complement this work with patient-specific modeling
and clinical data to enhance its translational potential. Future studies V. CONCLUSION
should aim to integrate more complex boundary conditions and real This study investigated the hemodynamics, wall shear stress
patient geometries to improve the applicability of computational (WSS), and wall shear stress gradient (WSSG) of two types of aortic
hemodynamic studies in clinical settings. Despite these limitations, our aneurysms: abdominal aortic aneurysm (AAA) and descending

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thoracic aortic aneurysm (DTAA). Due to variations in patient- importance of information and education,” Curr. Probl. Cardiol. 49, 102384
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2
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4
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ing of aortic aneurysm pathophysiology and provides valuable insights potential, and relative residence time,” Comput. Biol. Med. 154, 106609 (2023).
9
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ACKNOWLEDGMENTS 10
A. Buradi and A. Mahalingam, “Impact of coronary tortuosity on the artery
hemodynamics,” Biocybernetics Biomed. Eng. 40(1), 126–147 (2020).
This work has been supported by the TURK € IYE_ Burslari 11
M. S. Nagargoje, S. Asif, R. K. Nekkanti, K. Krishnakumar, S. K. Kannath, B. J.
(YTB) scholarship. I would like to express my sincere gratitude to Sudhir, and B. S. V. Patnaik, “Influence of carotid tortuosity on the hemody-
the Turkish government for providing this invaluable support, namics in cerebral aneurysms,” Phys. Fluids 35(6), 061908 (2023).
which has greatly facilitated my research.
12
Y. Qiu, D. Yuan, Y. Wang, J. Wen, and T. Zheng, “Hemodynamic investigation
of a patient-specific abdominal aortic aneurysm with iliac artery tortuosity,”
Comput. Methods Biomech. Biomed. Eng. 21(16), 824–833 (2018).
AUTHOR DECLARATIONS 13
J. Li, X. Cao, L. Xu, and L. Qi, “Finite element analysis for the effects of the
Conflict of Interest descending aorta tortuosity on aortic hemodynamics,” Procedia Comput. Sci.
209, 148–156 (2022).
The authors have no conflicts to disclose. 14
K. M. Klis, D. W ojtowicz, B. M. Kwinta, K. Stachura, T. J. Popiela, M. J.
Frączek, B. Łasocha, J. Gąsowski, O. Milczarek, and R. M. Krzy_zewski,
Author Contributions “Association of arterial tortuosity with hemodynamic parameters—A computa-
tional fluid dynamics study,” World Neurosurg. 180, e69–e76 (2023).
M. Abaid Ur Rehman: Conceptualization (equal); Data curation 15
K. Xu, L. Yu, J. Wan, S. Wang, and H. Lu, “The influence of the elastic modulus
(equal); Formal analysis (equal); Investigation (equal); Methodology of the plaque in carotid artery on the computed results of FFRCT,” Comput.
(equal); Project administration (equal); Resources (equal); Software Methods Biomech. Biomed. Eng. 23(5), 201–211 (2020).
16
(equal); Supervision (equal); Validation (equal); Visualization (equal); J. Benitez, D. Fontanarosa, J. Wang, P. K. Paritala, T. McGahan, T. Lloyd, and
Z. Li, “Evaluating the impact of calcification on plaque vulnerability from the
Writing – original draft (equal); Writing – review & editing (equal). aspect of mechanical interaction between blood flow and artery based on MRI,”
€ ur Ekici: Conceptualization (equal); Data curation (equal); Formal
Ozg€ Ann. Biomed. Eng. 49, 1169–1182 (2021).
analysis (equal); Investigation (equal); Methodology (equal); Project 17
G. B. Kim, K. H. Park, and S. J. Kim, “Hemodynamics and wall shear stress of
administration (equal); Resources (equal); Software (equal); blood vessels in aortic coarctation with computational fluid dynamics simula-
Supervision (equal); Validation (equal); Visualization (equal). tion,” Molecules 27(4), 1403 (2022).
18
K. Giannokostas and Y. Dimakopoulos, “TEVP model predictions of the pulsa-
tile blood flow in 3D aneurysmal geometries,” J. Non-Newtonian Fluid Mech.
DATA AVAILABILITY 311, 104969 (2023).
19
M. Fandaros, Y. Y. Li, J. J. Cao, and W. Yin, “A spatiotemporal analysis of the
The data that support the findings of this study are available left coronary artery biomechanics using fluid-structure interaction models,”
within the article and its supplementary material. Med. Biol. Eng. Comput. 61(6), 1533–1548 (2023).
20
C. Bilgi and K. Atal ik, “Effects of blood viscoelasticity on pulsatile hemody-
namics in arterial aneurysms,” J. Non-Newtonian Fluid Mech. 279, 104263
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