Hemodynamics and restenosis risk assessment in Budd-Chiari syndrome: A CFD study

Abstract

Background and ObjectiveBudd-Chiari syndrome (BCS) presents challenges in postoperative restenosis risk prediction due to unclear hemodynamic pathophysiology. Despite advances in interventional therapies, tools linking hemodynamic abnormalities to vascular remodeling are lacking. This study aimed to evaluate hemodynamic changes in BCS patients with inferior vena cava (IVC) stenosis using patient-specific MRI and computational fluid dynamics (CFD) to establish predictive biomarkers and optimize management.Methods3D IVC models were reconstructed from preoperative, postoperative, and healthy control MRI data. Dynamic hemodynamic parameters, including flow velocity, pressure gradients, wall shear stress (WSS), and vortex patterns, were analyzed via CFD simulations under physiologically accurate boundary conditions.ResultsPreoperative IVC stenosis caused severe disturbances. Post-intervention, parameters decreased (e.g., peak stenotic velocity from 1.91 m/s to 0.97 m/s; trans-stenotic pressure gradient from 3562 Pa to 1404 Pa) but remained higher than normal (peak velocity: 0.27 m/s; pressure fluctuation: Δ1225 Pa). Persistent vortices near stent edges and incomplete pressure normalization were observed, correlating with restenosis incidence. These findings highlight unresolved WSS (post-op peak WSS: 18.2 Pa vs normal: 6.18 Pa) and abnormal flow dynamics (e.g., prolonged vortex duration) as key recurrence risks.ConclusionThis study provides a hemodynamic framework for BCS, showing that intervention alleviates stenosis but doesn't restore normal flow. Residual stress emphasizes the need for adjunct therapies. The CFD approach offers predictive insights, advocating personalized monitoring for improved BCS outcomes.

Keywords: Budd-Chiari syndrome; computational fluid dynamics; hemodynamics; pre- and post-surgery.