Studying Peripheral Artery Disease Treatment With High-Resolution, Massively Parallel CFD Simulations

Peripheral arterial disease (PAD) refers to the impairment of blood flow to the peripheral arteries due to atherosclerosis. Clinicians rely on experience and established guidelines to develop treatment plans for patients undergoing revascularization because of the risk of limb loss. However, there has yet to be a consensus on the optimal treatment therapy. The ankle-brachial index (ABI) is a non-invasive, accurate method to assess the extent of PAD and response to therapy. Furthermore, endothelial shear stress (ESS) have been implicated in atherosclerotic pathologies. Hence, a patient-specific ESS and ABI pre- and post-intervention may provide insight into the mechanisms driving treatment outcomes for an individual patient. In this study, we develop a CFD framework, that utilizes 3D geometry of the major arteries generated from Computed Tomographic Angiography (CTA) of a cohort of patients, to compute patient-specific ABI and holistic ESS. The predictions from the framework were validated by comparing the computed and the measured relative ABI pre and post-intervention. The major traditional revascularization procedures were simulated to predict the patient-specific response. This work lays the critical foundation for a more evidence-based clinical decision-making.