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Review
. 2012;49(3):185-97.
doi: 10.1159/000335123. Epub 2012 Mar 14.

Twisted blood vessels: symptoms, etiology and biomechanical mechanisms

Hai-Chao Han  1
Affiliations
Review

Twisted blood vessels: symptoms, etiology and biomechanical mechanisms

Hai-Chao Han. J Vasc Res. 2012.

Abstract

Tortuous arteries and veins are commonly observed in humans and animals. While mild tortuosity is asymptomatic, severe tortuosity can lead to ischemic attack in distal organs. Clinical observations have linked tortuous arteries and veins with aging, atherosclerosis, hypertension, genetic defects and diabetes mellitus. However, the mechanisms of their formation and development are poorly understood. This review summarizes the current clinical and biomechanical studies on the initiation, development and treatment of tortuous blood vessels. We submit a new hypothesis that mechanical instability and remodeling could be mechanisms for the initiation and development of these tortuous vessels.

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Figures

Fig. 1
Fig. 1
Schematics of various phenotypes of tortuous vessels. Left to right: curving, angulation/kinking, looping and spiral twisting.
Fig. 2
Fig. 2
Tortuous collaterals form after occlusion of a femoral artery (from [45]).
Fig. 3
Fig. 3
Definitions of tortuosity indices. The integrated curvature of the middle panel is equal to the cumulative sum of angles α1–α4.
Fig. 4
Fig. 4
Comparison of stresses in normal and tortuous arteries. a Illustration of uniformly distributed lumen shear stress (τ) and tensile stresses in the axial, circumferential, axial and radial directions (σz, σΘ and σr, respectively). b Velocity profile at 3 axial locations and wall shear stress variation along the bottom side in a sinusoidal vessel obtained from computational simulations. c Axial wall stress distribution along the circumference at 2 peak deflection locations.
Fig. 5
Fig. 5
Photographs of an artery within a supporting matrix under elevated internal pressure buckling into tortuous shapes. a Under an internal pressure (140 mm Hg) beyond its critical pressure (80 mm Hg) in PBS solution. b Under an internal pressure (230 mm Hg) beyond its critical pressure (150 mm Hg) in gelatin. (Photographed by Mr. Shawn Lamm in the author's laboratory).
Fig. 6
Fig. 6
A proposed new mechanism for the initiation and development of vessel tortuosity.
See this image and copyright information in PMC

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