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Clinical, Hemodynamical and Mechanical Aspects
187
Figure 5. Example of fenestrated suprarenal stent-graft for treatment of AAA with narrow neck: (a)
assembly of a composite stent-graft with two renal branches; (b) angiograph demonstration of renal
branch stenting via the stent-graft fenestration; (c) 3D reconstruction of implanted suprarenal stent-graft
with renal branches using computed tomography (CT) (R- right, H-head, A-anterior); (d) the numerical
structure domain of the endograft assembly: main endograft (green), renal branches stent-grafts (purple)
and arterial sections (red). Diagonal stripes indicate full constrain at distal ends.
Thus, investigation of the flow forces and stresses on the graft may help minimize
complications and improve the endograft design. The following analysis [10] demonstrates
the stress developed in juxta-renal f-EVAR stent graft, using a numerical simulation of a post-
grafted endograft assembly as shown in Figure 5.
The main body fenestrated endograft is a combination of Nitinol stent chains sewn to a
Dacron graft envelope (see Figure 5). The Nitinol chains cope with the external pressure
loads, preventing the endograft from collapsing inwards, while the Dacron graft copes with
internal pressure loads such as blood pressure. In practice, the Nitinol chains are active at
locations where the endograft is pressed against arterial wall, and the Dacron graft is active
mainly where the endograft is immersed in the aneurysm sac and not in contact with the
arteries. In the presented model, we assumed that for a main body endograft in a supra-renal
aneurysm, only the Dacron graft contributes to stresses and displacements. Therefore, the
main body structure (green in Figure 5d) was approximated to be a uniform Dacron shell
layer of 0.1 E=3 GPa, Poisson Ratio of
=0.29 and
density of
=1.4 g/ml. The two renal stent-grafts (purple in Figure 5d) were modeled with
linear effective properties of stent-graft as specified by Li and Kleinstreuer [6] of E=10 MPa,
Poisson Ratio of
=0.27 and density of
=6 g/ml. These renal branches were connected to the
main endograft body using rigid links with fully constraint joints. The grafts were connected
at all their distal ends to arterial sections (red in Figure 5d) which were assumed homogenous,
linearly elastic and isotropic with E=1 MPa
=0.49 and
=1 g/ml[11]. These arterial sections
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Moshe Brand, Idit Avrahami, Asaph Nardi et al.
188
were fully fixed at their proximal ends (diagonal stripes in Figure 5d). Assuming no blood
leakage from the endografts, at the outer surface of the endograft a uniform pressure of 6
mmHg was set, modeling the intra-abdominal pressure [12].
The flow and pressure fields inside the graft's lumen were calculated using CFD in a
similar manner as described above. Since the fluid domain changes with wall displacements,
the Arbitrary Lagrangian-Eulerian (ALE) moving mesh approach was used to adjust the fluid
mesh to the boundary motion [13]. Thus, the local (Eulerian) velocity of the fluid relative to
the moving mesh V is:
(2)
where and are the mesh (Lagrangian) and absolute velocity vectors, respectively.
At the fluid-structure interfaces, displacement compatibility (for no-slip and no-penetration
conditions) and traction equilibrium were applied:
(3)
where and are the fluid and solid velocity vectors at the interface, respectively and
and are the fluid and solid stress tensors at the interface, respectively.
The boundary conditions were similar to those specified in the simulations above. The
structural mesh consisted of three different mesh groups (main endograft, two renal stent-
grafts and arteries). The total mesh model consisted of about 30,000 3D shell elements. Small
deformations and small strains were considered in the simulation. For each case, four cardiac
cycles were calculated (0 sec<t<3.2 sec) with total 800 time steps per cycle. The results of the
third cycle were fully periodic.
The structural analysis of the supra-renal graft reveals minor displacements in the graft
with maximal displacement of 0.4 mm near the proximal connection to the aorta. These
displacements are mainly due to arterial flexibility under pulsation stretching forces.
Effective stresses were calculated at each point according to Von-Misses criteria.
Elevated effective stresses are found in the graft iliac bifurcation, at the renal branches
connections, and where the Dacron graft is connected with the aorta and with the iliac
arteries. Highest stresses are found during peak systole (t=1.9 sec) at the iliac bifurcation.
Elevated effective stresses are also found at the renal branch connection. Figure 6 shows
time-dependent effective stresses at these locations. Cyclic stress is found at the iliac
bifurcation (blue line) and at the renal branch connection (purple line). In addition, time-
dependent total drag force, acting on the graft by the fluid is shown (green line), with
maximal force of 7.36 N at peak systole.
Maximal stresses are found at the graft iliac bifurcation in range of 400 to 670 kPa. These
values are in the range of values calculated by Li and Kleinstreuer [6] which calculated
maximal stress of 560 kPa at the bifurcation of infrarenal stent-graft.
However, their calculation ignored gravity, which is an important factor in these large
scale flow calculations. Moreover , the calculated total force values in the range of 4.6-7.3 N
meshabs
VVV
mesh
V
abs
V
sf
ττUV ;
V
U
f
τ
s
τ
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Clinical, Hemodynamical and Mechanical Aspects
189
agree with previous studies [14, 15] and may explain main EVAR complications, among
them graft migration, endoleaks, stent fatigue and fracture, and suture rupture [2, 16, 17].
Figure 6. Time dependent results of effective stresses at the graft iliac bifurcation (blue) and at the
connection to renal branch (purple); and of total drag force on the graft (green).
Figure 7. Examples of clinical failures of renal branches: (a) angiograph demonstration of a fraction in
the renal branch stent; (b) a CT image of implanted super-renal stent-graft with a leak from the renal
branch fracture; (c) fenestrated stent-graft with renal branch occlusion (CT image).
Other locations with elevated stress were found at the connections to renal branches, with
frequent cyclic stresses of 220 to 380 kPa. These findings suggest possible risk for local
fracture or detachment of the branched endografts, as well as potential for tissue overgrowth
and occlusion at the renal bifurcations. Figure 7a and 7b illustrate clinical examples in which
broken or disconnected branches were observed. In these cases, branch disconnection allows
blood to leak into the aneurysm. This might increase the pressure inside the aneurysm and
lead to aneurysm enlargement and rupture [18]. Post-procedural leakage is therefore the chief
cause of aneurysm-related mortality (ARM) and the need for either open surgical or
endovascular re-interventions [16]. In addition, twisted renal branches (similar to the right
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Moshe Brand, Idit Avrahami, Asaph Nardi et al.
190
renal branch in our model) might induce elevated velocities and pressure reduction near the
connection between the branch stent and the renal artery. This in turn, might cause
obstruction of the target artery [19-21] as shown in Figure 7c. In order to allow an effective
and safe alternative for open surgery procedure, fenestrated endografts for suprarenal
endovascular aneurysm repair should be designed with great attention. This study proves that
specific care should be given to the branching area, to avoid endograft detachment, fracture or
twists and to prevent interference of mal-positioned endografts to the renal flow.
REFERENCES
[1] Xenos, M. and D. Bluestein, Biomechanical Aspects of Abdominal Aortic Aneurysm
(AAA) and its Risk of Rupture: Fluid Structure Interaction (FSI) Studies. Biomechanics
and Mechanobiology of Aneurysms, 2011: p. 181-220.
[2] Sun, Z. and T. Chaichana, Fenestrated stent graft repair of abdominal aortic aneurysm :
hemodynamic analysis of the effect of fenestrated stents on the renal arteries. Korean
Journal of Radiology, 2010. 11(1): p. 95-106.
[3] Frauenfelder, T., et al., Computational fluid dynamics: hemodynamic changes in
abdominal aortic aneurysm after stent graft implantation. Cardiovascular and
Interventional Radiology, 2006. 29(4): p. 613-623.
[4] Antón, R., et al. Experimental and Numerical Analysis of the Pressure Field in a
Patient-Specific AAA Model with and without Intraluminal Thrombus. in
Cardiovascular Fluid Mechanics: from theoretical aspects to diagnostic and therapeutic
support. EUROMECH, 526. 2011. Cagliari, Italy.
[5] Rissland, P., et al., Abdominal aortic aneurysm risk of rupture: patient-specific FSI
simulations using anisotropic model. Journal of biomechanical engineering, 2009. 131:
p. 031001.
[6] Li, Z. and C. Kleinstreuer, Blood flow and structure interactions in a stented abdominal
aortic aneurysm model. Medical engineering and physics, 2005. 27(5): p. 369-382.
[7] Zarins, C.K. and C.A. Taylor, Endovascular Device Design in the Future:
Transformation From Trial and Error to Computational Design. Journal of
Endovascular Therapy, 2009. 16(SupplementI): p. 12-21.
[8] Greenberg, R.K., et al., Beyond the aortic bifurcation: branched endovascular grafts for
thoracoabdominal and aortoiliac aneurysms. Journal of vascular surgery: official
publication, the Society for Vascular Surgery [and] International Society for
Cardiovascular Surgery, North American Chapter, 2006. 43(5): p. 879.
[9] Chuter, T.A.M., et al., Endovascular treatment of thoracoabdominal aortic aneurysms.
Journal of Vascular Surgery, 2008. 47(1): p. 6-16.
[10] Avrahami, I., et al., Hemodynamic and mechanical aspects of fenestrated endografts for
treatment of Abdominal Aortic Aneurysm. European Journal of Mechanics-B/Fluids,
2012. 35: p. 8591.
[11] Fung, Y.C., Biomechanics: mechanical properties of living tissues1993: Springer.
[12] De Keulenaer, B.L., et al., What is normal intra-abdominal pressure and how is it
affected by positioning, body mass and positive end-expiratory pressure? Intensive care
medicine, 2009. 35(6): p. 969-976.
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Clinical, Hemodynamical and Mechanical Aspects
191
[13] Bathe, K.J., Finite element procedures, page 768. Englewood Cliffs, NJ: Prentice Hall,
1996.1996.
[14] Howell, B.A., et al., Computational fluid dynamics within bifurcated abdominal aortic
stent-grafts. Journal of Endovascular Therapy, 2007. 14(2): p. 138-143.
[15] Morris, L., et al., A mathematical model to predict the in vivo pulsatile drag forces
acting on bifurcated stent grafts used in endovascular treatment of abdominal aortic
aneurysms (AAA). Journal of biomechanics, 2004. 37(7): p. 1087-1095.
[16] Desai, M., et al., AAA Stent Grafts : Past Problems and Future Prospects. Annals of
Biomedical Engineering, 2010. 38(4): p. 1259 - 1275.
[17] Figueroa, C.A., et al., Preliminary 3D computational analysis of the relationship
between aortic displacement force and direction of endograft movement. Journal of
Vascular Surgery, 2010. 51(6): p. 1488-1497.
[18] Jones, J.E., et al., Persistent type 2 endoleak after endovascular repair of abdominal
aortic aneurysm is associated with adverse late outcomes. Journal of Vascular Surgery,
2007. 46(1): p. 1-8.
[19] Conway, B.D., et al., Renal Artery Implantation Angles in Thoracoabdominal
Aneurysms and Their Implications in the Era of Branched Endografts. Journal of
Endovascular Therapy, 2010. 17(3): p. 380-387.
[20] Haddad, Fenestrated endovascular grafting : the renal side of the story. Journal of
Vascular Surgery, 2005. 41(2): p. 181.
[21] Sutalo, I.D., et al., Modeling of Antegrade and Retrograde Flow Into a Branch Artery of
the Aorta: Implications for Endovascular Stent-Grafting and Extra-Anatomical Visceral
Bypass. Journal of Endovascular Therapy, 2008. 15(3): p. 300-309.
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INDEX
1
10q23, 3
A
access, 23, 46, 123, 124, 125, 157, 161
accounting, 58
acid, 87
ADAM, 7, 8, 21, 22, 33, 131, 144, 150
adaptability, ix, 82, 111, 112, 113
adaptation, 163
adenocarcinoma, 79, 85
adenoma, 84, 85
adhesion, 14, 61, 79, 153
advancement(s), 111, 113, 161
adventitia, ix, 44, 58, 61, 81, 82, 86, 87, 88, 90, 91,
92, 93, 95, 96, 99, 101, 102, 103, 105, 107, 109,
111, 112, 113, 114, 116
age, ix, xi, 2, 6, 7, 8, 13, 15, 16, 22, 34, 39, 40, 42,
50, 54, 58, 73, 82, 84, 85, 87, 95, 96, 101, 102,
103, 107, 113, 139, 140, 141, 142, 143, 144, 145,
146, 147, 156, 164
aggregation, 4, 8, 182
aging population, 156
alcohol consumption, 22
aldosterone, 12, 13
algorithm, 9, 173
allele, 8, 9, 13, 14, 17, 18, 25
alters, 60
American Heart Association, 18, 19
amputation, 162
anatomy, vii, x, 46, 119, 120, 121, 122, 125, 128,
129, 130, 131, 134, 137, 138
angiogenesis, 111
angiography, ix, xi, 82, 84, 85, 121, 133, 169, 170
angiotensin converting enzyme, 77
angiotensin II, xi, 63, 76, 153, 155, 158, 160
angiotensin receptor blockers, 63
angulation, 33, 46, 56, 121, 122, 124, 126, 132, 133,
134, 163
anisotropy, 39, 53, 55, 56
ANOVA, ix, 82, 85, 88, 91, 92, 94
antioxidant, 71
antisense, vii, 1, 14
antisense RNA, vii, 1, 14
aorta, viii, xi, xii, 2, 3, 10, 12, 19, 23, 28, 32, 36, 41,
42, 43, 44, 46, 47, 48, 50, 53, 55, 56, 57, 58, 59,
63, 65, 66, 71, 78, 79, 82, 84, 85, 88, 92, 107,
109, 111, 113, 116, 117, 120, 122, 123, 128, 132,
137, 139, 140, 141, 147, 152, 155, 156, 157, 158,
159, 160, 162, 163, 165, 166, 167, 177, 181, 182,
183, 184, 185, 186, 188
aortic aneurysms, vii, viii, ix, 2, 3, 15, 16, 17, 19, 20,
21, 23, 24, 25, 26, 27, 28, 29, 31, 32, 42, 47, 48,
49, 50, 51, 52, 53, 54, 55, 56, 67, 70, 72, 73, 74,
75, 76, 77, 78, 79, 81, 82, 83, 110, 114, 115, 116,
117, 120, 128, 131, 132, 133, 134, 136, 137, 149,
150, 151, 152, 153, 154, 156, 158, 162, 163, 165,
166, 178, 182, 186, 190, 191
aortic hemodynamics, vii, xi, 48, 155, 157, 158
aortic regurgitation, 159, 166
aortic valve, 48, 164
apoptosis, 10, 14, 17, 18, 58, 61, 65, 75, 154
ARM, 189
arrest, 61
artery(ies), 7, 11, 14, 24, 36, 53, 58, 71, 74, 84, 85,
116, 120, 121, 122, 123, 125, 126, 128, 129, 132,
133, 144, 152, 160, 161, 162, 181, 183, 186, 187,
188, 190
assessment, vii, 48, 52, 115, 165, 166, 170, 171
asymmetry, 32, 41, 48, 53, 55, 83, 115, 116, 163
asymptomatic, xi, 2, 4, 5, 6, 18, 19, 32, 34, 35, 54,
58, 71, 127, 152, 155, 157
atherogenesis, 166
atherosclerosis, viii, 7, 8, 11, 24, 25, 27, 57, 58, 59,
63, 76, 82, 83, 85, 88, 90, 99, 103, 107, 117, 147,
156, 157, 162, 164, 166
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Index
194
atherosclerotic plaque, 64, 159, 164, 165
attachment, 126, 128, 134
autoimmune disease, 74
autoimmunity, 10
autopsy, 40, 85, 87
autosomal dominant, 3, 4, 7, 8
autosomal recessive, 3, 4, 7, 8
awareness, 143
B
Baars, 28
base, 13
base pair, 13
basic research, 72
Belgium, 4, 14, 15, 21, 155
beneficial effect, 63
beneficiaries, 145
benefits, x, 119, 136, 141, 146
benign, 126
bias, 129
biological behavior, 44
biological processes, 12
biomarkers, 32, 34, 47, 50, 54
biomechanics, 32, 34, 35, 37, 43, 47, 53, 72, 191
bleeding, 156
blood, viii, ix, x, 2, 9, 10, 11, 31, 32, 34, 38, 39, 45,
46, 48, 51, 57, 58, 60, 62, 63, 65, 70, 71, 79, 82,
83, 84, 112, 113, 119, 120, 125, 126, 128, 156,
157, 160, 162, 163, 164, 166, 170, 182, 183, 185,
186, 187, 189
blood circulation, 60
blood clot, 170
blood flow, viii, 31, 32, 39, 45, 46, 48, 51, 57, 58,
60, 65, 70, 71, 82, 83, 84, 125, 157, 163, 166,
185, 186
blood group, 2
blood pressure, 10, 164, 187
blood supply, 182, 186
blood vessels, ix, 82, 112
body size, 22
bowel, 182, 186
branching, 182, 190
breakdown, 13, 147
breast cancer, 179
bronchial asthma, 64
brothers, 2, 5, 29
C
CAD, 144, 147, 170, 171, 174, 175
calcification, 40, 51, 78, 123, 134
calcifications, 32, 38, 40, 51, 53, 121
calcium, 65, 78, 158, 165
cancer, 26
candidates, x, 119
cardiac surgery, 76
cardiovascular disease(s), 8, 10, 64, 160
cardiovascular risk, 22, 143, 145, 147
cardiovascular system, 10, 158
cataract, 27
catheter, 44
Caucasians, 58
cDNA, 20
cell biology, 72
cell culture, 17, 64
cell cycle, 61
cell death, 61
cell invasiveness, 79
cell surface, 75
cerebral aneurysm, 156
cerebral arteries, 156
cerebrovascular disease, 7
chemical, 158
chemokines, 61, 71
chemotaxis, 71
children, 9
cholesterol, 63, 164
chromosome, vii, 1, 9, 13, 14, 15, 17, 23, 24, 25, 26
chronic obstructive pulmonary disease, 7, 147
cigarette smoking, 7
circulation, xii, 120, 125, 170, 181, 182, 185
classes, 174
classification, xi, 3, 55, 84, 125, 137, 169, 171, 174,
175, 176, 177, 178, 179
clinical symptoms, 126
clinical trials, x, 62, 139, 143
clustering, 2, 6
clusters, 15
coding, 10, 13, 16, 17, 27
coenzyme, 63, 76
collaboration, 135
collagen, viii, 8, 12, 13, 20, 24, 36, 40, 44, 57, 60,
66, 67, 70, 86, 87, 111, 147, 152, 157, 162
collateral, 125
colonization, 115
color, 160
commercial, 38, 183
community, 73, 146
compatibility, 188
compilation, vii
complexity, 49, 182
compliance, ix, 18, 50, 81, 82, 112
complications, x, xi, 62, 75, 119, 120, 121, 125, 133,
165, 169, 170, 187, 189
composition, 36, 39, 50, 115
computation, ix, 81, 82, 83, 110, 111
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Index
195
computational fluid dynamics, xii, 163, 166, 181,
182
computed tomography, xi, 52, 53, 121, 140, 150,
169, 187
computer, viii, 31, 39, 41, 42, 50, 115, 173, 178
computer simulations, viii, 31
computing, 115, 172
conference, 136, 179
configuration, 35, 38, 44, 46, 122
Congress, 151
connective tissue, 2, 60, 61, 71, 76
consensus, x, 19, 119, 127, 140, 150
constant rate, 146
constituents, 39, 44
construction, x, 82
contradiction, 65
control group, viii, 57, 83, 85, 88, 90, 94, 99, 103,
107, 146
controlled studies, 143
controlled trials, 46, 62, 64, 143, 144
controversies, 111
COPD, 84, 85, 144, 147
coronary arteries, 156
coronary artery disease, 7, 8, 11, 14, 15, 17, 27, 147
correlation(s), 3, 7, 33, 34, 35, 36, 37, 41, 111, 132,
133, 172, 174
cost, 18, 43, 75, 142, 147, 149, 150, 151
cost effectiveness, 147, 151
cotton, 65
covering, 186
CT scan, ix, 49, 82, 110, 140, 159
CTA, xi, 121, 126, 169, 170, 171, 172
culture, 63
cycles, 183, 188
cytokines, 10, 12, 24, 61, 63, 71
D
danger, 170
data set, 171, 174
database, 3
deaths, x, 2, 58, 139, 141, 146, 156, 182
defects, 20, 35
deficiencies, 64
deficiency, 148, 153, 158, 165, 166
deformation, 44, 49
degradation, 7, 8, 39, 44, 58, 60, 61, 65, 70, 75, 78,
113, 156, 157, 165
demographic data, 83, 85
Denmark, 15, 141, 142, 147
deposition, viii, 44, 57, 65, 70, 163
deposits, 67
derivatives, 76
destruction, viii, ix, 57, 60, 70, 71, 82, 101, 109, 112,
113
detachment, 182, 186, 189
detection, 4, 22, 53, 62, 121, 127, 141, 143, 145,
146, 170, 178
diabetes, 8, 15, 23, 42, 59, 147, 152
diabetic patients, 148
diastole, xii, 181, 184, 185
diastolic pressure, 83
dietary habits, 6
digestion, 60
dilatation, viii, xi, 2, 18, 22, 57, 58, 59, 60, 65, 66,
70, 88, 94, 96, 101, 105, 111, 113, 117, 120, 127,
136, 156, 181, 182
dilatation in the thoracic, xi, 181
dilation, 59, 60, 63, 165
discrimination, xi, 169
disease gene, 8
diseases, 7, 8, 16, 22, 27, 59, 84, 85, 144
disorder, 20, 58, 62, 72
displacement, xi, 36, 49, 78, 157, 169, 170, 173, 188,
191
distribution, viii, 31, 39, 41, 51, 52, 55, 117, 145,
161, 164, 166, 172, 173, 178, 184, 185
diversity, 162
dizygotic twins, 6
DNA, vii, 1, 2, 9, 10, 13, 14, 16, 27
DNA sequencing, 10
doctors, 72
down-regulation, 70
drugs, 62, 63
durability, x, 120, 131, 132
dynamic viscosity, 183
E
ECM, 3, 10, 11, 12, 13, 58, 59, 60, 61, 70
ECM degradation, 10
education, 150
Ehlers-Danlos syndrome, 3, 20, 21
elastin, viii, 3, 7, 13, 16, 34, 36, 40, 44, 57, 60, 61,
65, 66, 67, 70, 71, 75, 79, 147, 152, 156, 157, 162
eligibility criteria, x, 120
elongation, 46
elucidate, ix, 17, 58, 161
elucidation, 64
emboli, 59, 122, 126, 135, 182
embolization, 122, 126, 135
emergency, 34, 62, 115, 128, 149, 186
emission, 52
encoding, 3, 10, 11, 15
endocytosis, vii, 1
endothelial cells, 17, 162
endothelial dysfunction, viii, 58
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Index
196
endothelium, 79
endovascular, vii, viii, x, 19, 31, 32, 33, 44, 46, 47,
48, 50, 52, 54, 56, 75, 78, 110, 114, 115, 116,
119, 120, 125, 127, 128, 129, 131, 132, 133, 134,
135, 136, 137, 138, 140, 150, 170, 178, 189, 190,
191
Endurant Stent-Graft System, x, 120
energy, 37
energy density, 44
engineering, 133, 167, 190
England, 45, 49, 142, 146, 166
enlargement, 56, 60, 63, 132, 136, 189
enrollment, 46
entropy, 172, 173
environmental effects, 6
enzymatic activity, 154
enzyme(s), 8, 12, 13, 25, 62, 63, 71, 74, 77, 113,
148, 149, 154
enzyme inhibitors, 25, 74, 77
epidemiologic, 17, 83, 85
epidemiology, 22, 72, 131, 149, 150
equilibrium, 9, 188
erosive gastritis, 85
estrogen, 10
ethnicity, 8
etiology, 72
Europe, x, 139, 146
EVAR, viii, x, xi, 31, 32, 33, 44, 46, 50, 54, 62, 119,
120, 121, 122, 123, 125, 126, 127, 128, 129, 130,
131, 132, 133, 134, 136, 137, 140, 149, 169, 170,
171, 177, 178, 182, 186, 187, 189
evidence, vii, 1, 2, 8, 10, 17, 34, 40, 59, 61, 62, 71,
129, 131, 145, 146, 147, 148, 150
evolution, x, xi, 39, 54, 77, 82, 84, 109, 111, 113,
117, 120, 135, 139, 140, 169, 170, 171, 175, 177,
178
examinations, 83
exclusion, 120, 122, 123, 148
exercise, 48, 148, 154, 163
expert systems, 179
expertise, 46, 72
exposure, 6, 58, 78
extracellular matrix, viii, 3, 11, 12, 25, 57, 58, 61, 70
extraction, xi, 169, 171, 172
F
families, 2, 4, 5, 8, 9, 19, 23, 24, 29
family history, 2, 4, 5, 6, 7, 8, 16, 23, 28, 36, 58, 143
family members, 4, 5, 6, 16
family physician, 18
Federal Government, 145
fiber(s), viii, 36, 40, 44, 57, 60, 65, 66, 67, 70, 87,
111
fibrin, 39, 40, 113
fibrinogen, 34
fibroblast growth factor, 78
fibroblasts, 65
fibrosis, 111
fibrotic adventitia, ix, 82, 112
fibrous tissue, 111
Finland, 5
first degree relative, 4
first generation, 120
fixation, x, 46, 75, 78, 120, 122, 123, 124, 125, 127,
128, 136, 137
flexibility, 188
flow field, xi, 155, 157, 161, 166, 184, 185
flow velocities, xi, 155
fluid, viii, 31, 34, 39, 41, 43, 44, 45, 48, 49, 51, 52,
53, 55, 56, 79, 126, 162, 163, 183, 185, 188, 190,
191
focal dilatation, xi, 155
folic acid, 153
follicles, 87
force, 46, 49, 127, 128, 188, 189, 191
formaldehyde, 87
formation, ix, xi, 2, 6, 15, 22, 47, 58, 59, 60, 61, 62,
63, 64, 65, 70, 71, 78, 109, 114, 153, 154, 155,
157, 158, 159, 161, 163, 164, 165, 166, 167, 182
formula, 41, 56
fractures, 125
fragments, 61
G
gastritis, 84, 85
gene expression, 25, 71, 72, 113
gene therapy, 114
genes, vii, 1, 2, 3, 9, 10, 11, 12, 13, 16, 17, 24, 25,
26, 156, 159, 164
genetic defect, 158
genetic disease, 2, 7, 24
genetic factors, 2, 7
genetic marker, 9, 10, 152
genetic testing, 16
genetics, 6, 19, 21, 25, 72
genome, 10, 15, 24, 25
genome-wide, vii, 1, 2, 9, 17, 27
genomic regions, 9
genomics, 24
genotype, 3, 9, 27, 59, 152
genotyping, 10, 15
geometrical parameters, 49
geometry, xi, 41, 43, 52, 53, 110, 155, 157, 159, 160,
163, 166
grades, 87, 95, 96
grading, 133
https://t.me/med1917
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