Computational simulation of biomechanics in e-PTFE and venous Miller's cuffs: implications for intimal hyperplasia.

A computational distal end-to-side Miller's cuff anastomotic model was used to analyse the possible difference in intimal hyperplasia (IH) formed between e-PTFE and venous cuffs. A large strain FEA model was used to compute the strain after physiological loading and the deformed geometries used as wall boundaries for CFD analysis. Regression analysis was performed to investigate relationships between mechanical factors and prior IH. The results showed that the venous Miller's cuff anastomosis deformed twice as much as the e-PTFE cuff and that the expansion of both cuffs generated elevated strains in the artery floor while the fluid shear indices were qualitatively similar in each case. In the e-PTFE cuff, the strain and OSI correlated with IH in a proportional and equivalent manner; however, these regressions grossly over-estimated the predicted IH in the vein cuff. Thus, biomechanical effects may be important in synthetically cuffed anastomoses, but do not account for the reduced IH in venous cuffed anastomoses.