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ARTERIAL WALL MECHANICS – A REVIEW

Sarangi Somnath 1; DasBakshi Somnath 2; Bhattacharyya Ranjan 3; Mohanty Akhandal 4


Department of Mechanical Engineering, Indian Institute of Technology Kharagpur
Kharagpur-721302, India,
Email: 1 somsara@mech.iitkgp.ernet.in
2
@iitkgp.ac.in
3
rbmail@mech.iitkgp.ernet.in
4
rakhandal@iitkgp.ac.in

Abstract: The paper attempts a review of various recent advances in the field of Arterial wall mechanics starting with a
detailed description of the composition and microstructure of the artery .The various forces that influence arterial wall
mechanics are also discussed. The mechanical properties and various constitutive models are also discussed. Finally
various experimental techniques, applications and future perspectives have also been looked at.

Keywords: composition, microstructure, arterial wall mechanics, constitutive models, applications, future perspectives.

1. INTRODUCTION It’s the subendothelial layer which is mainly responsible


for load carrying capacity of the artery. The presence of
Arteries have thicker walls and tend to have narrower Type I and type III collagen confirms mechanical
lumens. The lumen diameter varies with position of dominance of subendothelial layer. Orientation of
artery in body. Diameter decreases with increasing collagen fiber varies, and thus acts as a separator, with
distance from heart. Other properties like stiffness also the thickness in subendothelial layer (11, 12).
changes with changing diameter. Arteries have to
constrict and dilate to control how much blood flows 2.2. TUNICA MEDIA
where, and they must bear the powerful force generated
by the heart. Because of the large amount of muscle in It is the middle layer of artery which is of greatest
their walls, they are usually round when cut in cross- volume and responsible for most of arterial properties
section. Though arteries collected from different region consist of a three dimensional network of smooth muscle
of body shows different characteristics artery walls cells, elastin. and bundles of collagen fibrils (type I about
mainly composed of three layers tunica intima, tunica 30% and type III about 70%) (13, 14, 15). For arteries
media and tunica adventitia. closer to heart the elastin proportion is higher (called
elastin arteries and have larger diameter) and for arteries
2. ARTERIAL COMPOSITION AND MICR- away from heart muscle cell proportion is higher (called
OSTRUCTURE muscular arteries located near the periphery). The
former are elastic “storage” vessels, while
2.1. TUNICA INTIMA the latter are controllable “resistance”
vessels Elastin, collagen and smooth muscle cells
Intima is the innermost layer of artery. A single layer of together form a continuous fibrous helix which is almost
endothelial cell, linked by numerous junctions providing circumferentially oriented within the media. Smooth
mechanical and electrochemical connection (1, 2), in muscle cells regulate blood flow locally by modifying
intima prevents blood from adhering to lumenal surface wall properties.
thus acting as a non-thrombogenic interface between
blood and vessel wall. Apart from that it also controls the
vessel wall permeability to macro molecules and white 2.3. TUNICA ADVENTITIA
blood cells. It has also been observed that endothelial
cells are responsible in vascular smooth muscle cells Adventitia means the outermost connective tissue
response to change in stress due to bl ood flow (3, 4, 5, covering any organ, vessel or any other structure. The
6). Though detail study in this field is still unavailable it outermost layer of artery is called adventitia because it is
has been found that a short term response is generated considered extraneous to artery. It consists of type I
due to alternation in flow and changes in vessel diameter collagen, nerves, fibroblast (a cell capable of forming
(7, 8, 9) as well as a long term effect aligns the collagen fibre) and some elastin fibers (16). The collagen
endothelial cell with the direction of flow (10). fibres form two helically arranged families of fibres
Endothelial cells are composed of type IV collagen, within which the individual collagen fibres have large
fibronectine and laminin . In addition to that a deviation from their mean orientation. Apart from
subendothelial layer of varying thickness is also present. connecting blood vessel to surrounding tissues adventitia
acts as a protective sheath which prevents over distension 2.4.2. ELASTIN
of media. It is also believed that adventitia has Elastin is a protein similar to collagen and is the principal
contribution in elastic modulus of vessel wall (17). component of elastic fibres. Elastic fibres occur as
accompanying structure of collagen fibre in vascular
wall. Elastin is a type of chemically inert protein and has
some properties similar to rubber. Among biosolid
materials it has the most linear elastic curve. It can
ramify hence forms networks. It is synthesized by
smooth muscle cells in vascular wall with decreasing rate
of synthesis with increasing age (21, 22, 23).

In arteries ratio of elastin to collagen is not constant and


it falls with increasing distance from heart while the
muscle cell proportion increases (24, 25, 26). In artery
cross section ring of elastin can be found between which
muscle cells are embedded that are surrounded by
collagen fibres.

3. IDENTIFICATION OF FORCES INFLUENCING


THE MECHANICS

Transmural pressure is the pressure difference between


inside and outside of any structure for example of blood
Figure1 Diagrammatic model of major components of vessel. Perfusion pressure is the pressure head or
healthy, elastic artery difference in pressure between two points in a fluid flow
tube. In blood vessel perfusion pressure between two
2.4. MICROSTRUCTURE points can be obtained by subtracting the transmural
pressure corresponding to those two points. The degree
2.4.1. COLLAGEN of pressure present in the cavity of the colon is called
intraluminal pressure. When a shear force is applied,
Collagen is fibrous protein constituent of bone, cartilage the layer nearer the wall than a layer inside it tends to
and other connective tissues. Collagen imparts slow its movement, while it in turn slows the movement
mechanical integrity and strength. It is main constituent of the layer just inside it nearer the axis. Higher relative
of artery wall. Collagen is synthesized by cells with high velocity of the layers with respect to one another occurs
metabolic activity. In blood vessel they are synthesized in smaller tubes such as arterioles, because there are
by vascular muscle cells and by endothelial cell as well fewer layers with smaller diameters. Residual stress is
(18). First procollagen is synthesized intracellular and observed in many parts of the cardiovascular system and
then extracellular procollagen is combined with is thought to reduce transmural stress gradients due to
tropocollagen which self assembles into collagen fibres intravascular pressure. Its development is closely
spontaneously. Collagens are of various types (19) like associated with normal growth and pathological
type I, II, III, IV. Collagen type II is found in hyaline and remodelling. The residual stress increases with growth
elastic cartilage and as its index of reflection is very and ageing. Pulse wave plays a dominant role in
similar to that of ground substance it is masked but they regulating flow across blood vessel. If the flow wave
are visible in polarizing microscope and electron generated by the heart comes across a change in
microscopy. While type III collagens are of reticular characteristic impedance due to stiffness or lumen cross
fiber type help in stabilization of reticular connective sectional area or both a reflective wave generates. When
tissue in fat cells type IV collagens are without a fibre the impedance increase then reflection is said to be
structure and have amorphous structure synthesized by positive and in this case pressure increases and flow
endothelial cells. While the former are found in media decreases. Alternatively if pulse wave faces decrease in
surrounding elastic fibres the latter are found in basement impedance then negative reflection occurs and this leads
membrane. Type I collagen is most common in human to fall in pressure and increase in flow.
artery (20) they are of high tensile strength, occurs in
wavy bundles and is stiffer than other varieties. It is 4. MODELLING MECHANICAL PROPERTIES
composed of collagen fibres which in turn are composed
of microfibrils. Microfibrils are composed of 4.1. HETEROGENITY
tropocollagen molecules.
On the microscopic level, healthy arteries are not opened configuration to represent all layers. Despite the
homogeneous. The wall is comprised of cells, elastin, existence of axial residual stress (42), only one model
and collagen, and the distribution of these elements includes it (43).
varies from the inner wall to the outer wall, as well as 4.4. SMOOTH MUSCLE CONTRACTIBILITY
along the vascular tree. Ultimately, the unknown
interaction of the fibrous constituents determines the Smooth muscle contractibility was modelled by Rachev
mechanical properties of the extracellular matrix (27). To & Hayashi (44) using different functional forms for the
complicate matters further, the orientations of elastin and active and passive circumferential stress.
collagen are load dependent making it likely that the ∂W
measured mechanical properties also change with load. σ θ p = λθ2 +q
∂E 0
In a heterogeneous model, parameters depend on the wall σ θ a = Mλθ f (λθ ),
constituents and their spatial distribution. Heterogeneity
where σθp represents the passive circumferential stress,
has been modeled using approaches of increasing
and σθa represents the active circumferential stress, λθ is
complexity: from a model having a two-layered cross
the circumferential stretch, q is an unknown scalar
section that represents the distinct wall layers in healthy
function determined from equilibrium and boundary
vessels (28), to models that account for healthy and
conditions, W is the strain energy density function, Eθ is
diseased histologic components (29), to models that
the circumferential Green’s strain, M reflects the level of
further include tissue microstructure (e.g., extracelular
smooth muscle contractile activity, and f(λθ) is a
matrix fiber distributions) (30).
normalized function accounting for the length-tension
relationship. The total circumferential stress is the sum of
the active and passive components. Active axial and
4.2. INCOMPRESSIBLITY
radial components were not modelled.
The incompressibility constraint requires the
4.5. PRESSURE RELATED DYNAMIC WALL
conservation of wall volume during the deformation of a
MOTION
material (31, 32, 33). Incompressibility is a reasonable
assumption in that biological tissues contain mostly
Demiray & Vito (45) introduced dynamic radial wall
water, which is incompressible at physiologic pressures.
motion in an elastic, homogeneous, isotropic,
Incompressibility has been modeled either by
incompressible, cylindrical artery. If (R, Θ, Z) and (r, θ,
constraining constitutive equations directly or using
z) are the cylindrical polar coordinates of a body before
Lagrange multipliers. Both approaches make use of the
and after deformation, wall motion caused by time-
fact that, for an incompressible deformation, the
dependent internal pressure and axial force may be
determinant of the deformation gradient is unity.
described as
4.3. RESIDUAL STRESS R2
r = r ( R, t ) = [ + C (t )]1 / 2
λz (t )
θ =Θ
If an artery piece is cut longitudinally it gets opened up
and this testifies the existence of residual stress (34). It z = λz (t ) Z ,
was first observed by Bergel (35). Vaishnav and
Vossoughi (36, 37) were the first to incorporate residual where C(t) is an unknown function, assumed to be of the
stress and strain in theoretical models, followed by Fung sinusoidal form with diastolic and systolic boundary
and co-workers (38, 39, 40). Inclusion of residual stress conditions used to solve for the unknown parameters, and
in arterial models results in a more uniform distribution λz is the axial stretch, further assumed to be constant for
of stress, noticeably decreasing stress at the intimal layer, simplicity.
as compared to models without residual stress. Current
models incorporate residual stress using a cut-open ring 4.6. SUMMARY OF BIOMECHANICAL BEHAVI-
segment as the zero-stress state. In one approach, the OUR
opening angle is measured and included in the
circumferential stretch ratio used to calculate strain (41). Blood vessels exhibit numerous complex characteristics.
This method uses incompressibility to relate the radii and Historically, observed characteristics have been
opening angle. Alternatively, strain is referred to inner implemented using simplifications of the actual
and outer surfaces in the stress-free configuration without behaviour, such as layered or otherwise distinct
the use of the incompressibility assumption. Although structures to represent the heterogeneity of the wall, a
individual arterial layers may each have their own single stress-relieving cut through the entire wall to
opening angles, all of the reviewed studies use a single account for residual stress and strain, assigning different
stress equations to account for active and passive
responses, and utilizing sinusoidal equations to account In vivo studies also yield very important information.
for wall motion. Even though the simplified mechanisms Studies are performed regularly in the clinical setting
cannot completely explain the actual behaviour, using invasive [intravascular ultrasound (IVUS),
important information is often revealed when the angiography] or non-invasive (magnetic resonance
simplifications are included. imaging, ultrasound) imaging methods to study blood
pressure; changes to vessel geometry (49); state of
5. CONSTITUTIVE MODELS disease; and responses to external stimuli, such as
exercise and pharmacological agents. Increasingly,
A constitutive relation is to be formed to describe the clinical instrumentation is also used for in vivo or in vitro
behavior of an artery. Constitutive equation does not laboratory testing (50, 51).
describe a material in particular but it describe its
behavior under particular condition. So for different
condition different constitutive equations are required. 7. APPLICATIONS
As far as artery material is concerned to model its
viscoelasticity, pseudoelasticity we need to have different Angioplasty is the medical alteration of a narrowed or
constitutive relations. Here only relations for totally obscured vascular lumen generally caused by
pseudoelastic behavior will be studied as this is sufficient atheroma (the lesion of atherosclerosis). In the
to quantify stress field in an artery under physiological angioplasty procedure, the physician threads a balloon-
loading condition. tipped catheter – a thin, plastic tube—to the site of a
narrow or blocked artery and then inflates the balloon to
Blood vessels can be treated as pseudoelastic, randomly open the vessel. The balloon is then deflated and
elastic, poroelastic, or viscoelastic. Pseudoelasticity removed from the artery. Vascular stenting, which is
assumes that a material can be modeled using separate often performed at the same time as an angioplasty,
equations describing the loading and unloading behavior. involves the placement of a small wire mesh tube called a
In most experiments, loading in one direction is generally stent in the newly opened artery. This may be necessary
accompanied by unloading in another, making a precise after some angioplasty procedures if the artery is very
definition of pseudoelasticity problematic. One possible narrowed or completely blocked. There are many other
solution is random elasticity, which assumes that the interesting and challenging application areas that will
strain response for a given load is centered around a benefit from more comprehensive blood vessel
definite value that lies on a well-defined curve, such that constitutive models. These include the creation of new
data from both the loading and unloading curves can be blood vessel substitutes (52), including the emerging
included simultaneously. Poroelastic formulations treat a field of vascular tissue engineering (53, 54) and
material as a fluid-saturated porous medium and are well aneurysm treatment and prevention (55, 56, 57).
suited to model wall transport. Viscoelastic formulations
include time-dependent responses in the constitutive
equation and are useful for modelling creep, stress 8. CONCLUSIONS AND FUTURE DIRECTIONS
relaxation, and hysteresis
Blood vessels exhibit complex interacting mechanical
6. EXPERIMENTAL TECHNIQUES and biological behaviours that are important but poorly
understood. Experimental models exist to isolate
Computer controlled experiments now provide more observed behaviour, whereas mathematical models exist
accurate data measurement and support a greater variety to model the observed behaviour. The need remains for
of testing conditions. The first microprocessor controlled models of increasing complexity, and numerical and
biaxial experimental system was developed by Vito (46). experimental data to complement these models. The
More recently systems have been built to control blood predictive value of current and future models will be
vessel inflation, axial stretch and torsion (47). assessed through implementation in relevant applications.

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