To cite this article: Kh. S. Mekheimer & M. A. El Kot (2010) SUSPENSION MODEL FOR BLOOD
FLOW THROUGH ARTERIAL CATHETERIZATION, Chemical Engineering Communications,
197:9, 1195-1214, DOI: 10.1080/00986440903574883
Download by: [Birla Institute of Technology and Science] Date: 03 October 2017, At: 04:46
Chem. Eng. Comm., 197:1195–1214, 2010
Copyright # Taylor & Francis Group, LLC
ISSN: 0098-6445 print=1563-5201 online
DOI: 10.1080/00986440903574883
This article is concerned with the analysis of a dusty model for the axi-symmetric flow
of blood through coaxial tubes such that the outer tube with an axially nonsymmetreic
but radially symmetric mild stenosis and the inner tube have a balloon (assumed that
is axi-symmetric in nature). The mild stenosis approximation is used to solve the
problem. To estimate the effect of the stenosis shape, a suitable geometry has been
considered such that the axial shape of the stenosis can be changed easily just by vary-
ing a parameter (referred to as the shape parameter). The model is also employed to
study the effect of the volume fraction density of the particles C, the maximum height
attained by the balloon d2, the radius of the inner tube, which keeps the balloon in
position j, and the axial displacement of the balloon xd. Flow parameters such as
velocity, the resistance to flow (the resistance impedance), the wall shear stress
distribution in the stenotic region and its magnitude at the maximum height of the
stenosis (stenosis throat) have been computed numerically for different shape para-
meters n, C, d2, j, and xd. It is shown that the resistance to flow decreases with
increasing values of the parameter determining the stenosis shape n and the axial
displacement of the balloon xd, while the resistance to flow increases with the volume
fraction density of the particles C, the radius of the inner tube, which keeps the balloon
in position j, and the maximum height attained by the balloon d2. The magnitudes of
the resistance to flow are higher in the case of a dusty fluid model than in the case of a
Newtonian fluid model. The wall shear stress distribution in the stenotic region and its
magnitude at the maximum height of the stenosis possess a character similar to the
resistance to flow with respect to C, d2, j, and xd. Finally, the effect of the volume
fraction density of the particles C, d2, and xd on the velocity profile are discussed.
Introduction
One of the leading causes of death in the world is heart diseases, and the most
common types are ischemia, atherosclerosis, and angina pectoris. Ischemia is the
deficiency of oxygen in a part of the body, usually temporary. It can due to a
constriction (stenosis) or obstruction in the blood vessel supplying that part. Athero-
sclerosis is a type of arteriosclerosis. It comes from the Greek words athero (meaning
1195
1196 K. S. Mekheimer and M. A. El Kot
means narrowing of any body passage (tube or orifice), is thus an abnormal and
unnatural increase in the arterial wall thickness that develops at various locations
of the cardiovascular system under diseased conditions.
The study of fluids with solid particles has been the object of scientific and
engineering research for a long time. The theoretical description of this system of
fluids is very useful in understanding various engineering problems concerned with
powder technology, rain erosion of guided missiles, sedimentation, atmospheric
fallout, combustion, fluidization, electrostatic precipitation of dust, nuclear reactor
cooling, acoustics batch settling, aerosol and paint spraying, aircraft icing, flows
in rocket tubes where small carbon or metallic particles are used, lunar ash flows,
environmental pollution, and many other practical problems. This subject is also
used in medicine, where erythrocyte sedimentation has become a standard clinical
test, and in oceanography as well as other fields. Some of the studies consider that
blood is a two-phase fluid, where the particulate phase is the red blood cells and
the fluid phase is the plasma, which is considered as a Newtonian fluid. The particu-
late suspension theory of blood has recently become the object of scientific research
(Srivastava and Srivastava, 1989). The investigation treated blood as a single-phase
Newtonian or non-Newtonian fluid and thus failed to provide an estimate of red cell
concentration on the blood flow characteristics. It is well accepted that blood can no
longer be treated as a single-phase Newtonian viscous fluid, so we can consider that
blood is a two-phase fluid, where the particulate phase is the red blood cells and the
fluid phase is the plasma (Srivastava and Srivastava 1983; Saxena and Srivastava,
1997; Markatos, 1986).
A number of researchers have studied the flow of blood through stenosed
arteries (Pralhad and Schulz, 2004; Srivastava, 1995; Srivastava, 1985; Chakravarty
and Mandal, 2000; El-Shahed, 2003; Jung et al., 2004; Ang and Mazumdar, 1997;
Liu et al., 2004; Liu and Tang, 2000; Haldar, 1985; Mandal, 2004). Srivastava and
Saxena (1997) considered that blood is represented by a two-fluid model with central
(core region) layer of suspension of all the erythrocytes assumed to be a particle (red
cell)-fluid (plasma) mixure and studied the blood flow through stenotic arteries with
a cell-free plasma layer. Recently, Politis et al. (2007) carried out a comparative
study of simulated blood flow in different configurations of simplified composite
arterial coronary grafts (CACGs) for three-dimensional, laminar, and steady flow
and a Newtonian fluid. Also, computational fluid dynamics techniques were applied
for the simulation of multibranched CACGs under physiologically realistic inflow wave-
forms by the same authors (Politis et al., 2008).
Cardiac catheterization (also called heart catheterization) is a diagnostic
procedure that does a comprehensive examination of how the heart and its blood
vessels function. One or more catheters is inserted through a peripheral blood vessel
Suspension Model for Blood Flow 1197
in the arm (antecubital artery or vein) or leg (femoral artery or vein) with X-ray
guidance. This procedure gathers information such as adequacy of blood supply
through the coronary arteries, blood pressure, blood flow throughout chambers of
the heart, collection of blood samples, and X-rays of the heart’s ventricles or arteries.
Typically performed along with angiography, a technique of injecting a dye into the
vascular system to outline the heart and blood vessels, catheterization can aid in the
visualization of any blockages, narrowing, or abnormalities in the coronary arteries.
If these signs are visible, the cardiologist may assess the patient’s need and readiness
for coronary bypass surgery, or perhaps a less invasive approach, such as dilation of
a narrowed blood vessel either surgically or with the use of a balloon (angioplasty).
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In recent times, with the evolution of coronary balloon angioplasty, there has
been a considerable increase in the use of catheters of various sizes. These include
the guiding catheter, whose tip is positioned in the coronary ostium through which
the angioplasty catheter over the small guide wire is advanced, and also the Doppler
catheter, if used in the procedure with the tip positioned proximal to the coronary
lesion. The insertion of a catheter in an artery will alter the flow field and increase
the resistance. Therefore the pressure or pressure gradient recorded by a transducer
attached to the catheter will differ from that of an uncatheterized artery, and it is
essential to know the catheter-induced error. Even a very small angioplasty guide
wire leads to sizable increase in flow resistance (Sankar and Hemalatha, 2007).
Back (1994) and Back et al. (1996) studied important hemodynamic characteris-
tics like the wall shear stress, pressure drop, and frictional resistance in catheterized
coronary arteries under normal as well as the pathological situation of a stenosis
present. The effect of catheterization on various flow characteristics in a curved artery
was studied by Karahalios (1990) and Jayaraman and Tiwari (1995). Dash et al. (1996)
studied the changed flow pattern in narrow artery when a catheter is inserted into it
and estimated the increase in friction in the artery due to catheterization using a Cas-
son fluid model for steady and pulsatile flow of blood. Also, Muthu et al. (2003) stud-
ied the model of arterial catheterization by considering the effect of elastic wall motion
on oscillatory flow of micropolar fluid through an annulus. Sankar and Hemalatha
(2007) studied pulsatile flow of Herschel-Bulkley fluid through catheterized arteries.
The purpose of this invistigation is to study arterial catheterization (widening of
arteries by a balloon in the presence of mild stenosis), when blood is represented by a
two-fluid model of particle-fluid suspension. The effects of resistance to flow, the
wall shear stress distribution in the stenotic region, and its magnitude at the
maximum height of the stenosis are discussed numerically and explained graphically.
where d0 is the radius of the artery in the non-stenotic region, b is the length of the
stenosis, n ( 2) is a parameter determining the shape of the constriction profile and
referred to as the shape parameter (the symmetric stenosis occurs for n ¼ 2), and a
indicates its location (as shown in Figure 1). The parameter g is given by
d1 nn=ðn1Þ
g¼ ð3Þ
do bn ðn 1Þ
b
where d1 denotes the maximum height of the stenosis located at x ¼ a þ n1=ðn1Þ , d2 is
the maximum height attained by the balloon at x ¼ xd þ 0.5, jdo is the radius of the
inner tube, which keeps the balloon in position, j << 1, and xd represents the axial
displacement of the balloon.
It is assumed that blood is represented by fluid of suspension of all the erythro-
cytes assumed to be a particle (red cell)-fluid (plasma) mixture. The equations
governing conservation of mass and linear momentum for both the fluid and particle
phase using a continuum approach are expressed as (Srivastava and Srivastava,
1983, 1989; Srivastava and Saxena, 1997):
Fluid phase:
@uf @uf @ð1 CÞp
ð1 CÞqf uf þ vf ¼ þ ð1 CÞls ðCÞr2 uf þ CSðup uf Þ
@x @r @x
ð4Þ
@vf @vf @ð1 CÞp
ð1 CÞqf uf þ vf ¼ þ ð1 CÞls ðCÞr2 vf þ CSðvp vf Þ ð5Þ
@x @r @r
Suspension Model for Blood Flow 1199
@ 1 @
fð1 CÞvf g þ fð1 CÞvf g þ fð1 CÞuf g ¼ 0 ð6Þ
@r r @x
Particle phase:
@up @up @Cp
Cqp up þ vp ¼ þ CSðuf up Þ ð7Þ
@x @r @x
@vp @vp @Cp
Cqp up þ vp ¼ þ CSðvf vp Þ ð8Þ
@x @r @r
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@ 1 @
fCvp g þ fCvp g þ fCup g ¼ 0 ð9Þ
@r r @x
with
2 1@ @ @2
r ¼ r þ 2 ð10Þ
r @r @r @x
where (uf, vf) are axial and radial velocities of fluid, (up, vp) are axial and radial
velocities of particle, qf and qp are the actual densities of the materials constituting
fluid and particulate phase, respectively, (1 C)qf is the fluid phase density, Cqp is
the particulate phase density, p denotes the pressure, C denotes the volume fraction
density of the particles, ls(C) is the particle fluid mixture viscosity (also the effective
viscosity of the suspension ls(C) ¼ lo when C ¼ 0), lo is the fluid (plasma viscosity),
and S is the drag coefficient of interaction for the force exerted by one phase on the
other. The expression for the drage coefficient of interaction, S, and the empirical
relation for the viscosity of the suspension, ls(C), for the present problem is selected
as (Srivastava and Saxena, 1997)
9 lo 0
s¼ k ðCÞ ð11Þ
2 a2o
4 þ 3½8C 3C 2 1=2 þ 3C
k0 ðCÞ ¼ ð12Þ
½2 3C2
and
lo
ls ¼ ls ðCÞ ¼
1 cC
1107
c ¼ 0:070 exp 2:49C þ expð1:69CÞ ð13Þ
T
The viscosity of the suspension expressed by Equation (13) and obtained by Charm
and Kurland (1974) has been found to be reasonably accurate for the value of C up
to 0.6. Charm and Kurland tested relation (13) with a cone and plate viscometer and
found it to be in agreement within 10% in the case of blood.
The boundary conditions that must be satisfied by the fluid on the walls are the
no-slip condition:
uf ¼ 0; up ¼ 0 at r ¼ RðxÞ ð14Þ
uf ¼ 0; up ¼ 0 at r ¼ hðxÞ ð15Þ
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x r uf bvf up bvp R
x0 ¼ ; r0 ¼ ; u0f ¼ ; v0f ¼ ; u0p ¼ ; v0p ¼ ; R0 ¼ ;
b do uo uo d1 uo uo d1 do
h p
h0 ¼ ; p0 ¼ ð16Þ
do qu2o
into Equations (4)–(10) and dropping the dashes. The appropriate equations
describing
the steady flow of a particle-fluid suspension in the case of a mild stenosis
d1
do << 1 , subject to the additional conditions (Srivastava and Saxena, 1997; Young,
1968)
1
d1 nn1
ðiÞ Re << 1 ð17Þ
b
1
do nn1
ðiiÞ Oð1Þ ð18Þ
b
may be written as
2
@p @ uf 1 @uf
¼ ls ðCÞ þ þ CMðup uf Þ ð19Þ
@x @r2 r @r
@p
¼0 ð20Þ
@r
qf @p
ðuf up Þ ¼ ð21Þ
ð1 CÞNqp @x
o o f u d q
where uo is the velocity averaged over the section of the tube of width do, Re ¼ ð1CÞl
o
o f sd 2 q
o f Sd 2 q
is the suspension Reynolds number, M ¼ ð1CÞl , and N ¼ ð1CÞq l are the suspen-
o p o
sion parameters.
The corresponding boundary conditions are
uf ¼ 0; up ¼ 0 at r ¼ RðxÞ
uf ¼ 0; up ¼ 0 at r ¼ hðxÞ
Suspension Model for Blood Flow 1201
where
with
d1 nn=ðn1Þ d1 a
g ¼ ; d1 ¼ ; r¼ ð23Þ
ðn 1Þ d0 b
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and
" 2 #
ðxd þ 0:5Þ
hðxÞ ¼ k þ d2 exp p2 b2 x rxrþ1
b
¼k otherwise ð24Þ
Noting the fact that p is a function of x only from Equation (20), Equation (19) is
rewritten in the form
@ 2 uf 1 @uf 1 dp
þ ¼ ð25Þ
@r2 r @r ð1 CÞls dx
r2
uf ¼ þ A logðrÞ þ B ð26Þ
ð1 CÞls
where A(x) and B(x) are the constants of integration. By using the boundary
conditions, we get
( !)
dp
dx 0 r2 logðRh Þ þ h2 logðRrÞ þ R2 logðhr Þ
uf ¼ l ð27Þ
4ð1 CÞlo logðRh Þ
q ¼ qf þ qp ð29Þ
( !)
dp
dx 0 4 4 ðh2 R2 Þ2
qf ¼ l R h þ ð30Þ
8lo logðRh Þ
1202 K. S. Mekheimer and M. A. El Kot
( ! )
dp
C dx ðh2 R2 Þ2 8ð1 CÞl2o 2
qp ¼ l0 R4 h4 þ þ ðR h2 Þ ð31Þ
8ð1 CÞlo logðRh Þ d02 S
and
( ! )
dp
dx 0 4 ðh2 R2 Þ2
4 2 2
q¼ l R h þ þ bðR h Þ ð32Þ
8ð1 CÞlo logðRh Þ
RR RR
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8Cð1CÞl2
where qf ¼ 2ð1 CÞ h ruf dr, qp ¼ 2C h rup dr, and b ¼ d 2 S 0 :
0
We can write Equation (32) in the form
dp
dx 1
q¼ ð33Þ
8ð1 CÞlo F ðxÞ
where
logðRh Þ
F ðxÞ ¼ ð34Þ
l0 fðR4 h4 Þ logðRh Þ þ ðh2 R2 Þ2 g þ bðR2 h2 Þ logðRh Þ
Resistance Impedance
The resistance to flow (resistance impedance) is obtained from Equation (35) as
Z a Z aþb Z L
Dp
k¼ ¼ 8ð1 CÞlo F ðxÞjR¼1;h¼j dx þ F ðxÞdx þ F ðxÞjR¼1;h¼j dx
q 0 a aþb
ð36Þ
where
logðkÞ
I¼ ð38Þ
fl0 ðð1 k4 Þ logðkÞ þ ðk2 1Þ2 þ bð1 k2 Þ logðkÞg
Suspension Model for Blood Flow 1203
@uf
sR ¼ ls ð39Þ
@r
By using Equation (16) and letting s0R ¼ slR udoo we can find the expression for the
o
dimensionless wall shear stress by
1 @uf
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sR ¼ ð40Þ
l0 @r r¼h
dp
¼ 8ð1 CÞlo qF ðxÞ ð42Þ
dx
Hence we have
( )
2R2 logðRh Þ þ R2 h2
sR ¼ 2q F ðxÞ ð43Þ
R logðRh Þ
We can note that the shearing stress at the stenosis throat (i.e., the wall shear at the
maximum height of the stenosis located at x ¼ ab þ n1=ðn1Þ
1
), i.e., ss ¼ sR jR¼1d1
8 9
<2ð1 d1 Þ2 log ð1d
h
Þ þ ð1 d1 Þ2 h2 =
ss ¼ 2q 1
J ð44Þ
:
ð1 d1 Þ log ð1d h
;
Þ 1
where J is defined by
J ¼ F ðxÞjR¼1d1 ð45Þ
We can find the final expressions for the dimensioless resistance to k, the wall shear
stress sR , and the shearing stress at the throat ss by
Z
b 1 aþb
k ¼ ð1 CÞ 1 Iþ F ðxÞdx ð46Þ
L L a
2R2 logðRh Þ þ R2 h2
sR ¼ F ðxÞ ð47Þ
R logðRh Þ
1204 K. S. Mekheimer and M. A. El Kot
2ð1 d1 Þ2 log ð1dh
þ ð1 d1 Þ2 h2
1Þ
ss ¼ J ð48Þ
ð1 d1 Þ log ð1d
h
Þ 1
where
k sR ss
k ¼ ; sR ¼ ; ss ¼ ;
ko so so
k0 ¼ 8lo L; so ¼ 2q ð49Þ
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and ko, so are the resistance to flow and the wall shear stress for a flow in a normal
artery (no stenosis).
However, in the limit d2 ! 0, Equations (46)–(48) reduce to the case that repre-
sents the flow of suspended-particle fluid through an annulus.
b
k ¼ð1 CÞ 1 I
L
Z ! #
1 aþb
logðRk Þ
þ dx ð50Þ
L a l0 fðR4 k4 Þ logðRk Þ þ ðk2 R2 Þ2 g þ bðR2 k2 Þ logðRk Þ
2R2 logðRk Þ þ R2 k2
sR ¼ ð51Þ
l0 RfðR4 k4 Þ logðRk Þ þ ðk2 R2 Þ2 g þ bRðR2 k2 Þ logðRk Þ
h n
k
ss ¼ 2ð1 d1 Þ2
log
2
þ ð1 d1 Þ k 2
l0 ð1 d1 Þ ðð1 d1 Þ4 k4 Þ
ð1 d1 Þ
k 2 2 2
log þ ðk ð1 d1 Þ Þ
ð1 d1 Þ
1
k
þbð1 d1 Þðð1 d1 Þ2 k2 Þ log ð52Þ
ð1 d1 Þ
2
sR ¼ ð54Þ
l0 R3 þ bR
2
ss ¼ ð55Þ
l0 ð1 d1 Þ3 þ bð1 d1 Þ
C ¼ 0), the results obtained in the present analysis reduce to the case of Newtonian
fluid as (Young, 1968)
Z
1 b 1 aþb dx
k¼ 0 1 þ ð56Þ
l L L a R4
2
sR ¼ ð57Þ
l0 R3
2
ss ¼ ð58Þ
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l0 ð1 d1 Þ3
Figure 2. Variation of dimensionless resistance to flow, k, with d1 for different values of C and n.
1206 K. S. Mekheimer and M. A. El Kot
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Figure 3. Variation of dimensionless resistance to flow, k, with d1 for different values of k and L.
Figures 10 and 11 represent the variations of the shearing stress at the stenosis throat,
ss , with d1 for different values of C, d2, j, and xd. The variations of dimensionless
resistance to flow, k, and the shearing stress at the stenosis throat, ss , with C for dif-
ferent values of stenosis size d1 and d2 are displayed in Figures 12 and 13. Finally, the
effect of C, d2, and xd on the axial velocity profile uf are displayed in Figures 14–16.
Figure 4. Variation of dimensionless resistance to flow, k, with d1 for different values of d2 and n.
Suspension Model for Blood Flow 1207
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Figure 5. Variation of dimensionless resistance to flow, k, with d1 for different values of xd and n.
In Figures 2–5 we observe that the resistance to flow, k, or the impedance
experienced by the streaming fluid distribution over the whole arterial segment
increases with the volume fraction density of the particles C, the maximum height
attained by the balloon d2, radius of the inner tube, which keeps the balloon in
position j, and also with the stenosis size d1 , while it decreases with the axial
Figure 6. Dimensionless wall shear stress, sR , distribution in the stenotic region for different
values of C and n.
1208 K. S. Mekheimer and M. A. El Kot
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Figure 7. Dimensionless wall shear stress, sR , distribution in the stenotic region for different
values of d2 and n.
displacement of the balloon xd, the stenosis length L, and the shape parameter n and
attains its maximal in the symmetric stenosis case (n ¼ 2).
In Figures 6–9 we notice that the wall shear stress distribution sR decreases in the
converging region as the shape parameter, n, increases, while it increases in the diver-
ging region in a similar situation for any given n. For any given stenosis shape n the
wall shear stress, sR , steeply increases in the upstream from its approached value (i.e.,
Figure 8. Dimensionless wall shear stress, sR , distribution in the stenotic region for different
values of xd and n.
Suspension Model for Blood Flow 1209
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Figure 9. Dimensionless wall shear stress, sR , distribution in the stenotic region for different
values of k and n.
at x ¼ 0) to the peak value at the throat (sR ¼ ss ), then decreases in the downstream of
the throat and assumes its approached magnitude at the end point of the constriction
profile (i.e., at x ¼ 1). The rate of increase (with respect to the axial distance) of sR in
Figure 10. Variation of the dimensionless shearing stress at the stenosis throat, ss , with d1 for
different values of C and k.
1210 K. S. Mekheimer and M. A. El Kot
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Figure 11. Variation of the dimensionless shearing stress at the stenosis throat, ss , with d1 for
different values of d2 and xd.
the upstream of the throat decreases with the increasing values of n, whereas the rate
of decrease of the same in the downstream of the throat increases with n.
The wall shear stress distribution sR and its value at the throat, ss , possess the
variations similar to the flow resistance, k, with respect to C, d2, j, and xd, where
Figure 12. Variation of dimensionless resistance to flow, k, with C for different values of d1
and d2.
Suspension Model for Blood Flow 1211
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Figure 13. Variation of dimensionless shearing stress at the stenosis throat, ss , with C for
different values of d1 and d2.
ss is independent of the shape and thus assumes the same magnitude for any value of
n; see Figures 6–11.
In Figures 12 and 13 we study the variation both of resistance to flow, k, and the
shearing stress at the stenosis throat, ss , with the volume fraction density of the par-
ticles C for different values of d1 and d2. We observe that resistance to flow, k, and
shearing stress at the stenosis throat, ss , increases with increasing the stenosis size d1 ,
the maximum height attained by the balloon d2, and the volume fraction density of
the particles C.
Finally, Figures 14–16 show the effect of the volume fraction density of the
particles C, d1 , and d2 on the axial velocity profile. It is observed that as C, d1 ,
and d2 increases the axial velocity uf decreases.
Concluding Remarks
This problem is concerned with the analysis of a dusty model for the axi-symmetric
flow of blood through coaxial tubes such that the outer tube with an axially non-
symmetric but radially symmetric mild stenosis and the inner tube have a balloon
(assumed that it is axi-symmetric in nature). The effect of the stenosis shape has been
considered such that the axial shape of the stenosis can be changed easily just by
varying a parameter (referred to as the shape parameter). The model studies the
effect of the volume fraction density of the particles C, the maximum height attained
by the balloon d2, the radius of the inner tube, which keeps the balloon in position,
and the axial displacement of the balloon xd on the flow characteristics, such as the
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axial flow velocity, the resistance to flow (the resistance impedance), the wall shear
stress distribution in the stenotic region, and its magnitude at the maximum height of
the stenosis (stenosis throat).
Graphical results for the flow characteristics are presented and the main findings
can be summarized as follows:
. The magnitudes of the flow characteristics (k; sR ; ss ) are higher in particle-fluid
suspension than that in particle-free flow (C ¼ 0).
. The magnitudes of the flow characteristics (k; sR ; ss ) are higher in arterial catheter-
ization analysis than those in artery without catheter.
. Although the effect of a mild stenosis on the gross flow characteristics (k; sR ; ss ) is
small, the present particle-fluid suspension analysis still shows that even a mild
stenosis increases the flow resistance significantly with an increase in the particle
concentration, and, hence, there would be a marked reduction in the flow to the
particular vascular bed supplied by the stenotic artery and there would be a
chance of abnormal cell proliferation.
. The increasing value of the shape parameter would cause a considerable increase
in the flow.
. The wall shear stress distribution in the stenotic region and its magnitude at the
maximum height of the stenosis possess a character similar to the resistance to
flow with respect to C, d2, j, xd.
. The axial velocity for a particulate phase decreases with C and d2 while it increases
with xd, and we notice a non-axi-symmetry for the axial velocity as d20.
. The results of Srivastava and Saxena (1997) in the case of one fluid model (a ¼ 1)
have been recovered by taking d2 ¼ 0 (no catheterization).
References
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