Blood flow quantification in the aortoiliac arteries: from bench to bedside

Stefan Engelhard

Research output: ThesisPhD Thesis - Research UT, graduation UT

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Aortoiliac occlusive disease (AIOD) is a form of peripheral arterial disease in the distal aorta and iliac arteries. The prevalence of AIOD increases with age, although the majority of patients experience no symptoms. The most common symptom of AIOD is intermittent claudication, or pain in the legs after walking for a short time, which subsides after a short rest. Ultimately, the disease can lead to critical limb ischemia and, in some cases, partial or complete amputation of a leg.

The disease can be treated with supervised exercise training. If this is not effective, or if the symptoms are severely debilitating, surgical or endovascular treatment is required. In endovascular treatment, one or more stents are often placed.

Although the pathological mechanisms behind AIOD are strongly influenced by local blood flow, this is not an important factor in the current diagnosis and treatment of the disease. Accurate quantification of these blood flow patterns could therefore improve treatment. A promising technique for this is echoPIV. The main goal of this thesis was to investigate the feasibility and clinical application of echoPIV, to bring this technique from the workbench to the patients bedside:

Chapter 2 describes the influence of local blood flow patterns on peripheral arterial disease and provides an overview of several novel techniques to measure these patterns.

In Chapters 4 and 5 echoPIV was tested in healthy volunteers. This showed that it is possible to accurately map the blood flow in the abdominal artery with echoPIV.

In Chapters 6 and 7, echoPIV was applied in patients with peripheral artery disease. This showed that it is also possible to blood flow disturbances in patients, even inside stents placed in the arteries.

In conclusion, EchoPIV was shown to be applicable in patients with AIOD. If the echoPIV technique is further developed and successfully implemented in clinical practice, it may lead to improved treatment, with local flow parameters adjusting the monitoring and treatment of the disease.

Original promotion date was January 13, 2022 (COVID-19)
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Twente
  • Reijnen, Michel, Supervisor
  • Versluis, Michel, Supervisor
  • Groot Jebbink, Erik, Co-Supervisor
Award date23 Mar 2022
Place of PublicationEnschede
Print ISBNs978-90-365-5319-3
Publication statusPublished - 23 Mar 2022


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