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Portal vein thrombosis (PVT) is a significant complication during both the pre-transplant and postoperative periods of liver transplantation. The multifactorial etiology of PVT, the paradoxical hemostatic state in liver cirrhosis and the limited usefulness of standard coagulation tests highlight the necessity of formalized models to assess thrombosis risk.

Objective: Using a mathematical model of the blood coagulation system, investigate the influence of hemodynamic conditions and coagulation factor levels on the likelihood of thrombus formation in the portal vein.

The portal vein is modelled as a flow-through reactor with rapid convective mixing. The mathematical model is based on Panteleev et al. (2010) detailed kinetic scheme, incorporating equations for the extrinsic pathway of coagulation activation, positive and negative feedback loops, and inhibition of active factors. The resulting system of ordinary differential equations was integrated using a one-stage Rosenbrock method with complex coefficients.

Thrombin generation was shown to exhibit threshold dependence on blood flow velocity. Above a critical velocity, the initiation phase does not transition to the amplification phase. This corresponds to physiological conditions that prevent thrombus formation. We demonstrated that, at reduced fibrinogen concentrations characteristic of hepatic dysfunction, the critical velocity threshold above which thrombus formation is suppressed increases. This indicates the system’s heightened susceptibility to stasis. Protein C deficiency had minimal effect on thrombogenesis dynamics under the modeled conditions. The modeling results qualitatively agree with clinical data on fibrinogen distribution in PVT patients ($n$ = 932, Sklifosovsky Research Institute).

In this paper a numerical model for blood flow through a venous bifurcation with an obliterating clot is investigated. We studied propagation of perturbations of blood flow velocity and perturbations of pressure inside the vein. The model is built in acoustic (linear) approximation. Computational results reveal conditions for clot resonance oscillation, which can cause its detachment and thromboembolism.

A mathematical model of fluid movement in the portal vein is considered. The fundamental circumstance determining the whole variety of portal hemodynamic phenomena is the absence of a valve apparatus. The flow direction is solely a function of the pressure gradient, and, therefore, it is fundamentally reversible when the boundary conditions of the system change.

Calculations were performed in the area representing a CT image fragment of the portal vein of a particular patient, which does not contain vascular bifurcations. The interpolation of patient Dopplerography data published in the press was used as boundary conditions for the flow. The calculations were carried out using the FlowVision industrial hydrodynamics software package. A comparison of calculations using the ideal fluid model and the Kuemada model of viscoplastic flow is carried out.

Calculations were performed for different values of the resistance coefficient corresponding to the physiological norm and with an increased value of the resistance coefficient.

At a normal value of the resistance coefficient, the flow in the portal vein is characterized by strong convective mixing.

As a result of calculations, it was found that when using the Kuemada model, the flow in the portal vein is stratified. The nature of the stratification depends on the hematocrit. At a normal value of the resistance coefficient, a plastic core of the flow is formed as the velocity decreases. With an increased value of the resistance coefficient during flow inversion, the flow core is also formed. When the flow is inverted, the plastic core continues to move in the forward direction, while the wall layers of the liquid begin to move in the opposite direction.

It is noted that in order to obtain correct modeling results, it is necessary to refine the blood composition of the portal vein and, possibly, refine the rheological model. Such information can be obtained both from comparing simulation data with clinical data, and by laboratory examination of portal vein blood.

Numerical modeling of shear-induced platelet activation in haemodialysis arteriovenous fistulas was carried out in this work. The goal was to investigate the mechanisms of threshold shear-induced platelet activation in fistulas. For shear-induced platelet activation to take place, shear stress accumulated by platelets along corresponding trajectories in blood flow had to exceed a definite threshold value. The threshold value of cumulative shear stress was supposed to depend on the multimer size of von Willebrand factor macromolecules acting as hydrodynamic sensors for platelets. The effect of arteriovenous fistulas parameters, such as the anastomotic angle, blood flow rate, and the multimer size of von Willebrand factor macromolecules, on platelet activation risk was studied. Parametric diagrams have been constructed that make it possible to distinguish the areas of parameters corresponding to the presence or absence of shear-induced platelet activation. Scaling relations that approximate critical curves on parametric diagrams were obtained. Analysis showed that threshold fistula flow rate is higher for obtuse anastomotic angle than for sharp ones. This means that a fistula with obtuse angle can be used in wider flow rate range without risk of platelet activation. In addition, a study of different anastomosis configurations of arteriovenous fistulas showed that the configuration “end of vein to end of artery” is among the safest. For all the investigated anastomosis configurations, the critical curves on the parametric diagrams were monotonically decreasing functions of von Willebrand factor multimer size. It was shown that fistula flow rate should have a significant impact on the probability of thrombus formation initiation, while the direction of flow through the distal artery did not affect platelet activation. The obtained results allowed to determine the safest fistula configurations with respect to thrombus formation triggering. The authors believe that the results of the work may be of interest to doctors performing surgical operations for creation of arteriovenous fistulas for haemodialysis. In the final section of the work, possible clinical applications of the obtained results by means of mathematical modeling are discussed.

The possibility of numerical 3D simulation of thrombi formation is considered.

The developed up to now detailed mathematical models describing formation of thrombi and clots include a great number of equations. Being implemented in a CFD code, the detailed mathematical models require essential computer resources for simulation of the thrombi growth in a blood flow. A reasonable alternative way is using reduced mathematical models. Two models based on the reduced mathematical model for the thrombin generation are described in the given paper.

The first model describes growth of a thrombus in a great vessel (artery). The artery flows are essentially unsteady. They are characterized by pulse waves. The blood velocity here is high compared to that in the vein tree. The reduced model for the thrombin generation and the thrombus growth in an artery is relatively simple. The processes accompanying the thrombin generation in arteries are well described by the zero-order approximation.

A vein flow is characterized lower velocity value, lower gradients, and lower shear stresses. In order to simulate the thrombin generation in veins, a more complex system of equations has to be solved. The model must allow for all the non-linear terms in the right-hand sides of the equations.

The simulation is carried out in the industrial software FlowVision.

The performed numerical investigations have shown the suitability of the reduced models for simulation of thrombin generation and thrombus growth. The calculations demonstrate formation of the recirculation zone behind a thrombus. The concentration of thrombin and the mass fraction of activated platelets are maximum here. Formation of such a zone causes slow growth of the thrombus downstream. At the upwind part of the thrombus, the concentration of activated platelets is low, and the upstream thrombus growth is negligible.

When the blood flow variation during a hart cycle is taken into account, the thrombus growth proceeds substantially slower compared to the results obtained under the assumption of constant (averaged over a hard cycle) conditions. Thrombin and activated platelets produced during diastole are quickly carried away by the blood flow during systole. Account of non-Newtonian rheology of blood noticeably affects the results.