Femoral artery hemodynamics: state of the art of computational analyses and future trends

Femoropopliteal artery (FPA), characterized by a unique extension and curvature, is often affected by atherosclerotic occlusive diseases, such as peripheral artery disease (PAD). The clinical trend for the treatment of the FPA has shown that none of the endovascular nor surgical treatments typically adopted for other vascular regions, including carotids and coronary arteries, provides a drawback-free follow-up. In particular, the mini-invasive approach is typically affected by restenosis and widely influenced by the environmental biomechanics of the FPA surrounding tissues. As it has been long known for other vascular districts, abnormal hemodynamics may be an important factor in driving the plaque development and restenosis in FPA. The tools to locally analyse hemodynamics in FPA are mainly computer-based; it means that the analyses are carried out by means of numerical simulations, like computational fluid dynamics (CFD) or fluid-structure interaction simulations. These analyses allow the assessment of the local distribution of hemodynamic descriptors according to the geometrical model under consideration. In this context, this short review gives insights on the main works on hemodynamic modelling of FPA, including an overview of the on-going work of our research group on this topic. Future perspectives are also provided with focus on computational models of FPA that take into account the impact of lower limb movement on hemodynamics and agent-based modelling coupled with CFD to inquire the cellular events.