Thermophysical characteristics of materials used in calculations [51, 52, 53, 54].
\r\n\tThe biological activities of the bioactive compounds are based on the lead or the privileged scaffold present in the structure. The different scaffolds present in natural bioactive compounds are indole, purine, chromone, coumarin, benzothiphene, lactone, etc. These privileged scaffolds modify into multiple molecules for having different bioactivity. Some of the bioactive compounds in large quantity have an adverse effect on health. Recently, bioactive compounds are widely used in green chemistry, nanotechnology, and metal chelation.
\r\n\tThe book provides a reference for a wide range including chemistry, analytical techniques, medicinal chemistry, pharmacology, nanotechnology, etc.
Careful preoperative evaluation of patients undergoing vascular surgical intervention holds great significance since this group of patients has almost the highest percentage of accompanying diseases with poor outcome. It is well-known that vascular disease – irrespectively of its manifestation – is a generalized disorder, the majority of patients with vascular disease smoke and have chronic pulmonary disease, also suffers from diabetes and hypertension.
Hypertension and diabetes are often associated with coronary artery disease which determines the short and long-term survival of vascular procedures. Coronary artery disease is one of the most frequent cause of the perioperative mortality and morbidity (1-5%). Goldman et al. drew the attention to the frequency of cardiac complication of vascular operations as far back as 1977 and aimed to establish a multi-factorial score index. Based on detailed surveys which covered a large patient population the perioperative incidence of myocardial infarction among patient undergoing vascular surgical procedures is 2,1 – 8,0 %, whilst the mortality is 0,6 – 5,4 %. These examinations did not consider the type of operations – open or endovascular. Beside Goldman’s classic risk index numerous task forces have established their own score system for the assessment of perioperative cardiac risk. All of these highlight the significance of the fact that after being aware of the clinical risk, consultation and mutual decision making of cardiologists, anesthetists and vascular surgeons in evaluation the long-term efficiency and risk ratio is essential. The most important weak point of all score system is the utilization of data derived from patients underwent elective operations. Kertai et al. developed a simplified risk index, which is suitable for the assessment of perioperative mortality of either acute or elective patients undergoing vascular surgical operations. The American College of Cardiologist and the American Heart Association has developed a guideline for the assessment of cardiovascular risk among patients with different diseases who are undergoing non-cardiac surgery. This guideline includes the risk assessment for the patient undergoing vascular surgery. Three categories of cardiac risk have been classified in the guideline, high, intermediate and low. High cardiac risk involves the history of acute coronary syndrome, congestive heart failure, significant arrhythmias and severe heart valve diseases. Among non-cardiac surgeries associated with higher cardiac risk, the acute operations, surgery on extremely old patient, operations of the aorta, prolonged operations, operations with excessive fluid or blood loss are considered to be high-risk while carotid endarterectomy should be considered within the intermediate-risk category. The most simple clinical determining factors of cardiac risk are the age, body weight, known diabetes, congestive heart failure, angina pectoris, history of myocardial infarction and previous coronary revascularization.
Preoperative examination should include the assessment of patient’s functional capacity.
In the presence of lower extremity peripheral vascular disease performing exercise stress test may be difficult, thus pharmacological stress test or specific upper body exercise test should be carried out. Severely impaired functional capacity further increases the cardiac risk. Diseases of the aorta are frequently associated with severe coronary artery disease/ The incidence and severity of coronary artery disease are remarkably higher at the diseases of the aorta.
Preoperative examination should include the following:
Assessment of cardiac risk using different noninvasive examinations.Noninvasive stress testing are the following: dipyridamole myocardial perfusion scintigraphy, radionuclide ventriculography, Holter ECG monitoring, dobutamine stress echocardiography. Several authors ( Eagle and collegues, Lee and coworkers) have examined the sensitivity and specificity of these methods, and have found the dobutamine stress echocardiography to be the most appropriate test to assess this group of patients. This examination not only assesses the left ventricular dysfunction but also provides other valuable information on the ground of echocardiography. However, choosing the most appropriate type of test is undoubtedly influenced by local availabilities and cost effectiveness, as well. After assessing the cardiac risk, what therapeutic options are available to decrease it? Beta-blocker therapy at high-risk vascular patient has been proven to improve not only the perioperative but also the long-term survival. Manago et al. carried out a study, which covered a large number of patients on the effect of bisoprolol and atenolol on mortality and cardiovascular morbidity after non-cardiac surgery. Treatment of hypertension: blood pressure fluctuation at high-risk vascular patients further increases the cardiac risk. Previous anti-hypertensive therapy should be broadened by administration of beta-blockers and the directly acting, alpha-2 agonist, clonidine. Perioperative ACE-inhibitors therapy may cause intraoperative hypotension, thus administration of them are not recommended.
What further medical therapy is available to decrease the perioperative risk?
Poldermans and colleagues evaluated the effectiveness of statin therapy, and they found that the perioperative statin therapy is associated with lower postoperative mortality.
Among the evaluated drug therapies, only the perioperative beta-blocker therapy has been found to significantly decrease the mortality. Increased risk of urgent surgery, especially in elderly patients, a longer surgery, excessive blood loss due to classify interventions in high-risk group.
Of smoking among patients with vascular risk factors are also important, so increased the perioperative complications between the role of pulmonary complications. Chronic obstructive pulmonary disease and chronic bronchitis, which often encounter. The kidney complications should be considered. First, the generalized vessel disease associated with hypertension, the renin-angiotensin system leads to damage, and the second associated with diabetes to nephropathy.
Growing the progressive aortic aneurysm rupture in the final output. In ruptured cases, the deaths of over 50% indicate a value and this value has not changed significantly over the past 40 years, developments in technology and the introduction of the endovascular technique does not like routine. If known and expanding aortic aneurysm is detected, and reconstruction is the surgical mortality rate is between 0.4 to 2.3%.
The technique of anesthesia during general anesthesia supplemented with epidural anesthesia benefits. We must work towards the introduction of anesthesia, the hemodynamic stability, to eliminate changes caused by intubation. Cross-clamping of the aorta, causes a sudden increse in the afterload. This growth, provoke arrhythmias and myocardial ischemia and left ventricular failure.
Aortic aneurysm rupture due to a significant amount of blood in the abdomen, in any event be deemed hypovolemic. The abdominal muscle tone affects the capacity for intra-abdominal blood vessels, this relaxation is terminated and the formation of the blood pressure to fall, then a further decrease in blood pressure by opening the abdominal cavity should be expected. So close to the team\'s work comes to the fore the importance of continued vigilance isolation inhalating 100% oxygen, and then rapidly after induction opening the stomach, fast and high aortic cross clamp immediately save the patient\'s life. This type of surgery with surgical mortality of 50% is over, and over the past 4 decades has not changed.
The anesthesia and surgical technique despite the development of the aorta during surgery thoraco-abdomial section of the complications and mortality has not changed significantly over the past 20 years. High-traffic, high number of sick institutions in 5-14% mortality rates reported.The paraplegia, paraparetikus complication rate of 50-40% of the shares are known. The percentage of complications depends on which section of the aorta, the exclusion should be carried out. The neurological complications after pulmonary complications to be expected. The monitoring of the thoracic aneurysm surgery should be extended. Close cooperation is required between the vascular surgeon and anesthesiologist, the surgical plan must be designed carefully crafted after, the every aspect of the monitoring and the distal aortic perfusion technique. Important aspects of the arteries of the spinal cord and the renal arteries perfusion ensure and the adequate oxygenation.
If the exclusion (cross clamping) is happening, a retrograde perfusion provides security for patients. In surgery for thoracic aortic aneurysm general anesthesia of suitable technology. The most important is protection of the spinal cord, 20-30 minute cross clamping time is safe for the patient. The hypothermia is one of the most suitable
method for neuroprotection.
The patient who has been diagnosed with significant coronary artery disease during preoperative examination and is a candidate for high-risk vascular surgery is the most challenging. In case of acute operation beta-blockers remains the only therapeutic option, while in elective patients coronary revascularization should be carried out.
If the vascular procedure is not urgent, CABG operation is preferable over PCI. Elective non-cardiac surgery is not recommended within 6 weeks of coronary revascularization with PCI and stent implantation. In these cases careful risk assessment and effectiveness evaluation is necessary. Among patients with vascular disease tobacco smoking is a significant risk factor, thus perioperative pulmonary complications are frequent. Chronic obstructive pulmonary disease and chronic bronchitis are the most common ones. Perioperative blood gas analysis can be useful in assessing the risk. If the arterial carbon-dioxide partial pressure is higher than 45 mmHg, the risk for postoperative pulmonary complication is increased. If a tobacco smoking patient is presented at the preoperative evaluation meeting 2-4 weeks prior to the operation, it is reasonable to try to persuade the patient to cease the cigarette smoking, although, cessation will increase the amount of bronchial discharge. Smoking cessation 2-3 days prior to the surgery only results in decrease of the blood carboxi-hemoglobin level. In case of history of COPD and asthma preoperative glucocorticoid therapy (40 mg of prednisolon for two days) can decrease the risk of pulmonary complications. Treating the bronchial spasm, mobilizing the bronchial discharge and performing chest physiotheraphy would improve the patients’ condition. One to two days prior to surgery preoperative pulmonary function test should be performed. Decreased FEV1/FVC ratio suggests obstructive pulmonary disease. Performing regional anesthesia can lower the operative risk by eliminating the administration of the respiratory depressive opiates. On the other hand intraoperative blood CO2 pressure monitoring is important, since the probability of developing hypercapnia is high, as well as the postoperative CO2 level follow up, since the pain can lead to hypoventilation. Thus adequate pain management is strongly advisable.
Renal complications should also be taken into consideration, because of the pre-existing hypertension which is usually accompanied to generalized vascular disease and which can lead to impairment of the renin-angiotensin system. Preexisting diabetic nephropathy can also influence the development of postoperative renal complications.
The final outcome of aneurysms that present progressive growth is the rupture. In case of aneurysm rupture the mortality reaches the 50 %, this ratio has not changed over the last 40 years, despite the technical development and the introduction and routine application of endovascular techniques. Postoperative mortality rate of reconstruction of previously known and growing aortic aneurysm varies from 0,4 to 2,3 percents.
Preparation for the operation includes setting up the following:
two 14 G peripheral venous line
central venous line
arterial line
ECG monitoring from 5 different points
pulsoxymetry
urinary catheter
gastric tube
body temperature monitoring
noninvasive blood pressure measurement (from the opposite side than the direct arterial pressure line)
In case of impaired ejection fraction (less than 30 %) or suprarenal aortic cross-clamping, routine monitoring should be completed by the use of PICCO or Swan-Ganz catheter. In case of patients with significant diastolic dysfunction continuous intraoprative TEE (trans-esophageal echocardiography) monitoring can help to evaluate the need of fluid or catecholamine therapy.
The anticoagulation maintained with use of heparin 100 unit/kg, additional heparin necessary if the clamping time prolonged. Heparin can be reversed by protamine ( 4mg/kg over 15 minutes ) it may lead to anaphylaxis, pulmonary hypertension and myocardial depression.
At aortic operations it is recommended to prepare 4 - 6 units of red blood cell transfusion, if possible, autologous transfusion should be performed. The use of cell saver (intraoperative cell salvage machine) improves the efficacy of transfusion therapy, if it is not available normovolaemic hemodilution is required. Hemodilution does not increase the oxygen deficit of the myocardium. During fluid therapy close monitoring the 24-hour diuresis and warming the fluid infusions increases patients’ safety. (Myers G)
During anesthesia, general anesthesia can be completed by the benefits of application epidural anesthesia. The thoracic epidurals decrease the stress response to surgical procedure. During induction of anesthesia care must be taken to maintain the patient’s hemodynamic stability and to eliminate the hyperdynamic response caused by the intubation. In case of aortic operation close attention must be paid to physiologic changes during aortic cross-clamping. In case of abdominal aortic operation the level of cross-clamping is infrarenal, i.e. aorta is fully cross-clamped under the origin of renal arteries. Changes in patient’s condition appear rapidly, thus taking prompt actions are necessary. Aortic cross-clamping causes sudden increase in systemic vascular resistance, i.e. in afterload. This increase can provoke myocardial ischemia, arrhythmia and left ventricular failure. The more proximal the cross-clamping is, the more severe the myocardial adverse consequences are. Administration of vasodilators and activation the epidural anesthesia before the cross-clamping can stabilize the patient’s condition and have beneficial effect. During aortic cross-clamping the lower extremities and certain parts of large intestines receive minimal blood flow through collateral circulation, but the renal circulation are also impaired. As a result of these circulatory changes inflammatory mediators are released by leukocytes, platelets and endothelial cells.
Cessation of aortic cross-clamping causes sudden decrease in afterload, which is on the one side caused by the discontinuation of mechanical obstruction but the accumulated vasodilator mediators by getting back into the systemic circulation plays also an important role in this. Beside vasodilation, metabolic acidosis and increased capillary permeability aggravates the condition. Providing adequate circulatory volume and maintaining stable blood pressure is necessary before releasing the aortic cross-clamp. Administering mannitol and pressor drugs can be helpful to fulfill this. Every efforts must be made in order to reach as short hypoperfusion time as possible.
In the postoperative period the close monitoring should be continued and care must be taken of the adequate pain management. If the infrarenal cross-clamp time exceeds 60 minutes, the subsequent pressure rise in the renal arteries may cause systemic hypertension in the early postoperative period, which is usually transient.
Patients require monitoring after abdominal aortic aneurysm operation. The postoperative pain management is important, the early extubation, and the enteral nutrition. Appropriate thrombotic profilaxis and postoperative gastrointestinal ulcus profilaxis, the use of antacids.
In case of acute operation of ruptured aortic aneurysm, the patient should be considered hypovolaemic under all circumstances due to the excessive amount of extravascular blood found in the abdominal cavity. Increased abdominal muscle tone has a pressor effect on the intraabdominal capacity vessels, which is ceased if muscle relaxants are administered during the anesthesia and this causes subsequent blood pressure drop. Hypotension is further aggravated by the opening of abdominal cavity. This fact underlines the importance of team work. Isolation and draping of the operative field is carried out while the patient is awake, under simultaneous 100 % of oxygen inhalation, followed by rapid induction, quick opening the abdominal cavity and immediate high aortic cross-clamp which actions can only save the patient’s life. Heparinization is not required until the aorta is not cross clamped. After the aorta is cross clamped the fluid resuscitation can be instituted with colloids and blood. The dilutional coagulopathy is precnse, FFP and platelets ordered for the patient, and heparin is omissioned. Mortality rate of these operations exceeds the 50 percents and has not changed over the past four decades. The predictors of the survival are the patients age, the total blood loss, and the time of hypotension.
Preparation for the operation includes setting up the following:
two 14 G peripheral venous line
blood count, electrolytes coagulation screen
arterial line
ECG monitoring from 5 different points
pulsoxymetry
urinary catheter
gastric tube
body temperature monitoring
noninvasive blood pressure measurement (from the opposite side than the direct arterial pressure line)
Drugs and fluids:
6-10 units of cross matched blood, fresh frozen plasma and platelets
Crystalloids and colloids
Inotropes (ephedrine 3 mg/ml, adrenaline 1:100 000) and vasopressor agents ( phenylephrine 100 mcg/ml, metaraminol 0.5 mg/ ml )
Operative complications and mortality rate of thoracoabdominal aneurysm surgeries has remained remarkably high despite the development of anesthetic and surgical techniques. High, 5-14 % of mortality rates have been reported by even specialized aneurysm centers which are dealing with a large number of patients. Paraplegia and paraparesis, as postoperative complications develop at 5 - 40 % of all cases. The incidence of complications is influenced by the site of the cross-clamp. The most commonly occurring neurological complications are followed by the pulmonary ones. At thoracic aneurysm operations more vital signs is required to be monitored. It also demands closer collaboration between the vascular surgeon and the anesthetist, because every step of the monitoring has to be set up after developing the operative plan. Particular attention must be paid to the perfusion technique of the distal aorta. Providing adequate perfusion of vertebral and renal arteries and application of satisfactory ventilation are also very important.
Preparation for the operation includes setting up the following:
High flow venous catheter, 2 peripheral venous line and 3-lumen central venous line
Radial arterial cannula, inserted in the right side if the cross-clamp is placed proximally to the left subclavian artery.
Femoral arterial cannula, if the bypass is used to maintain the distal aortic flow.
Radial + femoral, more information can be obtained about the circulation of the lower part of the body
Transesophageal echocardiography – intraoperative information: LVEDP, the myocardial function and the valves status
Preparation for unilateral ventilation
Positioning the double-lumen tube can be helped by bronchofiberoscopic intubation.
Ten units of red blood cell transfusion, FFP and platelet transfusion.
Monitoring of SSEPs (somatosensory evoked potentials)
Body temperature monitoring: core and peripheral temperature.
The aneurysm of the ascending aorta is destroyed, need an urgent surgical procedure.
If cross-clamping is applied, significant pressure elevation proximally to the cross-clamping is common. Administration of nitrates and vasodilators is recommended, in case of patient with preserved myocardial systolic function administration of isofluran and desfluran is also suggested. Nitrates can optimize the preload and are able to decrease the left ventricular wall tension. If the operation is performed under the protection of cardiopulmonary bypass (CPB), patient safety is improved if retrograde aortic perfusion is used. In order to ensure appropriate therapy, direct arterial pressure monitoring is registered from two separate regions, above and under the cross-clamping.
In case of thoracic aortic aneurysm surgery balanced anesthesia is the appropriate technique of choice. Protection of the vertebral spine is the most important task, from 20 to 30 minutes of cross-clamping time is considered to be safety. Spinal blood pressure is equal to the difference of mean distal aortic pressure and the cerebrospinal fluid pressure. Cerebrospinal fluid pressure is approximately equal to the central venous pressure. The spinal perfusion autoregulation is similar to the cerebral, appropriate blood flow is maintained between 60-120 mmHg of perfusion pressure.
Applying hypothermia is one of the best solution to ensure adequate neuroprotection, 32 – 34 degrees of Celsius of body temperature is recommended during the operation.
Impairment of renal circulation can also lead to severe complications, administration of mannitol and loop-diuretics and applying hypothermia can prevent these adverse outcomes.
During anesthesia strict attention must be paid to maintain the patient’s body fluid and electrolyte balance. If the procedure is done with the patient in the left lateral thoracotomy the CPB is constructed through the femoral artery with venous drainage through right atrial, bicaval, or femoral venous cannulation. Systemic hypothermia is used, with a circulatory arrest. Surface cooling is used along with core cooling and rewarming through the CPB heat exchanger. The cooling of the head with ice during core cooling and kept cold until the period of arrest is important. The core temperature is monitored in the esophagus or tympanic membrane. (Kumar N)
Drugs and fluids:
6-10 units of cross matched blood, fresh frozen plasma and platelets
Crystalloids and colloids
Inotropes (ephedrine 3 mg/ml, adrenaline 1:100 000) and vasopressor agents ( phenylephrine 100 mcg/ml, metaraminol 0.5 mg/ ml ).
It is very important during induction is to minimize the hypertensive response to laryngoscopy and intubation, which may lead to further spreading of the tear and result in rupture of an aneurysm or propagation of a dissection. Dispite the factthat we could make a long surgery, a large doses of pancuronium are generally avoided. This drug has a vagolytic and norepinephrine releasing effects, which produce hypertension and tachycardia. In patients with significant reduced myocardial function etomidate 0.2 to 0.3 mg/kg may provide the hemodynamic stability during induction. Anesthesia is maintained with inhalation agents, opiates and non-depolarizing muscle relaxants.
Airway management : lesions of the ascending and transverse aortic arch are managed with a single-lumen endotracheal tube. If the aortic lesions may cause tracheal or bronchial compression better to use a left-sided double-lumen tube (DLT). The tube should be placed with using fiberoptic bronchoscopy.
Bleeding and hematologic dysfunction: A thoracic aortic surgery involves using large amounts of blood. The amount of blood used for depends on the bypass time. The time of deep hypothermia has an effect on the clotting system.
Aneurysms of the descending thoracic and thoracoabdominal aorta
Aneurysm of descending thoracic aorta involves diffenert parts of the thoracic aorta and may extend to the abdominal aorta too. Several techniques can be used to control upper- and lower-body blood flow during the operation.
- Aortic cross-clamping, This is the method for resection in a short period of time. The problems are the organ ischemia because of arterial hypertension, and metabolic acidosis. The cross clamp duration and severity of complications is directly proportional. A cross-clamping time longer than 30 minutes increases the risk of spinal cord injury- Passive shunts, the most commonly used shunt is the 9-mm heparin-coated conduit (Gott shunt), which does not require systemic anticoagulation.- Centrifugal pump bypass flow, the left atriofemoral centrifugal pump bypass may be useful in patients with decreased left ventricular function, coronary artery disease, renal failere.. and anticipated longer then 30 minutes aortic cross-clamping time.- Partial Cardiopulmonary Bypass, it is used from the femoral vein to the femoral artery, or from the right atria to the femoral artery. This techique adds the use of oxigenator. - Deep Hypothermic Circulatory Arrest has been used to protect vital organs and the spinal cord. Despite the detailed research work has not found the perfect way to protect the spinal cord. Containing a high number of patients in studies based on the present position is that hypothermic protection with CPB and DHCA may be the useful methods.
Endovascular stent graft implantation is one of the most suitable alternatives to open aortic aneurysm surgery today. Aortic operations have remarkably changed since the introduction of endovascular techniques. Extremities of implantation technique have been reported in the scientific literature, from the stent-grafts implanted in the X-ray lab percutaneously toward the open stent-graft implantation procedures. Stent-graft implantation is less invasive, more tolerable for the patients, the length of surgery is shorter, less transfusion is required and the shorter ICU and hospital stay are also the advantages of this technique. Based on our experience stent-graft implantation is considered at those patients, who are referred to be high-risk due to the large number of severe accompanying diseases. In our institute we intend to perform epidural anesthesia at abdominal aortic aneurysm stent-graft repair operations and balanced anesthesia at thoracic cases. Standards of the monitoring technique are the same as that is described at the open procedures. Monitoring improves patient’s safety.
Preparation for the procedure includes setting up the following:
two 14 G peripheral venous line
laboratory exams : blood count, electrolytes, coagulation screen
arterial line
ECG monitoring from 5 different points
pulseoxymetry
urinary catheter
body temperature monitoring - prolonged operations
noninvasive blood pressure measurement (from the opposite side than the direct arterial pressure line)
At the endovascular procedures hemodynamic changes caused by the cross-clamping are not presented. The postoperative period is better tolerated, the pain is milder and the cardiovascular status is more stable. Endovascular stent-graft repair of aortic aneurysms. At present, aortic stent-grafts are most frequently used to repair infrarenal aortic aneurysms. The hemodynamic consequences of infrarenal endovascular balloon inflation are minimal compared with those of suprarenal, supraceliac, or thoracic aortic occlusion. More significant hemodynamic changes are likely to be encountered during stent-graft repair of the descending thoracic aorta.
The high-risk patients undergoing endovascular stent-graft aortic repair appear to have greater hemodynamic stability compared with for the traditional open technique was. Despite this, hypotension and hemodynamic instability could detected, especially during manipulation with expended balloon. Causes of hypotension include hemorrhage and loss of blood into the aneurysm sac after graft implantation, release of endothelial vasoactive substances, and/or an autonomic reflex in response to endovascular balloon inflation.Along the course of the operation, theres is a significant advamtage with the change int he opersation technique, and that the clamping of the aorta is left out or restricted to only a few minutes. During the positioning of the graft, the measured systemic vascular resistence increases but the value (9,2 ±3%)compared to total aortic clamping (32,8 ± 7,6 %) is significantly lower. At this point, following clamping of the abdominal aorta, we experienced a decrease in stroke volume and cardiac output which reached 38% in the cross clamping patients. In patients with stent graft technique this value remained under 9%. The decrease in venous backflow is much lower and therefore the decrease in end diastolic pressure is also lower which influences the left ventricular filling pressure. In a series of 12 patients undergoing infrarenal aortic repair with an EVT endovascular graft under neuroaxial blockade (epidural or continuous spinal), 25% of patients had sudden severe bradycardia and hypotension necessitating immediate therapy. Accordingly, blood must be immediately available, and large-bore intravenous access must be obtained before the procedure. Because of the high incidence of CAD, careful monitoring and aggressive treatment of myocardial ischemia is essential. Conversion to open repair may be required in 2% to 20% of patients (average, 9%) due to technical difficulty with graft deployment or acute surgical complications such as aneurysm rupture or arterial injury With increasing experience, the need for emergency conversion to open repair is decreasing to approximately 2% to 5% of cases but is still associated with increased morbidity and mortality in these high-risk surgical patients (Kumar N)
In patients with significant coexisting atherosclerotic vascular disease of major organs (heart, brain, kidneys), induced hypertension should be avoided altogether or its duration minimized. A stent-graft that does not require hemodynamic manipulations for its deployment would be more desirable in such patients. The anesthetic technique may consist of general anesthesia, regional anesthesia (epidural, spinal, or continuous spinal), or local anesthesia plus sedation. The choice of technique is influenced by multiple factors, including local customs and the experience of the surgical and anesthetic teams. Consideration should be given to the potential for intraoperative hemodynamic instability and the possible need to react rapidly to surgical complications. The anesthetic goals include analgesia, sedation, anxiolysis, patient immobility, and maintenance of hemodynamic stability. General anesthesia was the most commonly used method during the initial experience with endovascular infrarenal aortic repairs because it provided the ability to rapidly convert to open surgical repair. With evolving experience, regional anesthesia (epidural or spinal) and even local anesthesia with sedation and monitoring are being increasingly used for endovascular aortic repairs A variety of drugs have been used successfully for general anesthesia, including etomidate,, propofol, potent synthetic opioids, volatile anesthetics, and muscle relaxants In patients with severely impaired left ventricular function, etomidate together with a potent opioid such as fentanyl or sufentanil provides adequate hemodynamic stability. Advantages of regional anesthesia include minimization of systemic drug use, continuation of pain relief into the postoperative period, and the improved ability to detect symptoms of myocardial ischemia in patients who can report the occurrence of chest pain. Central neuroaxial blockade was shown to reduce the postoperative hypercoagulable state, which may result in a decreased incidence of deep vein thrombosis and vascular graft occlusion.
The infrarenal cross clamping acts on kidney function only bedside refle and hemodinamic changes. In our stent graft patients we did not experienced a decrease in the renal functions. The infrarenal aortic clamping convincingly increases renin release from the kidney. The increase in plasma renin and angiotensin levels causes a postoperative increase in blood pressure, compared to preoperative values. Because of the variable and unpredictable duration of these procedures, epidural anesthesia is the most commonly used technique because it has the flexibility of providing anesthesia of indefinite duration. Careful titration of the dermatomal level helps minimize the sympathectomy-related hypotension.
Continuation of epidural blockade beyond the operating room is an excellent method of providing postoperative analgesia. A normal coagulation profile must be assured before catheter placement and removal. Continuous spinal anesthesia using an intrathecally placed epidural catheter provides a more rapid onset of a more dense neuroaxial block than does epidural anesthesia. The stent graft technique not only makes the task of the surgeon easier but eases the work of the anesthesiologists. It is important to note that considering the high risk patients we cannot lax th tight monitoring end technical equipment which encure the patient’s safety and well being.
The decision of using endograft configuration in the RAAA depends of several factors. For the anesthesia the most important is the hypotension. We are in the position to use intra-aortic occlusion balloons in hemodinamically unstable patients, after the unsuccesfull volumen resuscitaion. It seems to be the hemodinamical instability is the most important factor of the survival in the patients with RAAA undergoing endovascular aortic aneurysm repair.
Hybrid solutions are called for vascular interventions, which are the traditional methods of open vascular surgery and insertion of the endograft are combined in order to reduce the risk of interference. The anesthesiologist must be always ready for a planned change in surgical technique, and the situation has changed to provide the surgeon and the patient to the optimal situation.
After revascularization of an acute arterial occlusion the development of a serious ischaemic-reperfusion injury is a menacing challenge and a hard task in vascular surgery. A whale of evidences point to oxidative stress, as an important trigger, in the complex chain of events leading to reperfusion injury.
Arató et al. made examinations, after reperfusion in the 2nd and 24th hours, and on 7th day. Superoxide-dismutase activity, reduced glutathion concentration and leukocytes free radical production were measured. The degree of lipidperoxidation was marked with the quantity of malondialdehyde. The expressions of adhesion molecules were measured with flowcytometry. The speed and rate of free radical production significantly increased in the early reperfusion (p < 0.05). The level of antioxidant enzymes decreased after revascularization. The CD11a and CD18 expression of the granulocytes significantly (p < 0.05) decreased right after the revascularization, but with a gradual elevation until the 7th day they exceed the ischaemic value. The results showed a time specific turnover of the sensitive antioxidant–prooxidant balance after revascularization operation.
Revascularization procedures performed on acutely ischaemized extremities are accompanied by metabolic and functional derangements which may be life threatening. Determination of selected biochemical, oxidative and inflammatory parameters which belong to the most objective criteria will alert physicians reducing the reperfusion injury cascade. Malondyaldehide plasma level has shown significant elevation after the operation and during reperfusion, it remained almost constant during first post operative week, this determines lipidperoxidation and membrane impairment (Fig. 1).
(∗∗p < 0.01; ∗∗∗ p < 0.001 vs. control).
Fig. 1. The malondialdehyde plasma concentration elevated significantly in all of the operated groups
During early reperfusion period GSH level dramatically diminished (p < 0.01) at the sam e time –SH groups levels also decreased (Figs 2 and 3).
(##p < 0.01 vs. ischaemia).,
Fig. 2. The plasma concentration of reduced glutathion (GSH) decreased significantly in the early, acute phase of reperfusion
Plasma concentration of –SH groups decreased significantly in the early reperfusion, then showed a slight elevation till the end of the week (##p < 0.01 vs. ischaemia, ∗p < 0.05 and ∗∗p < 0.01 vs. control).
Regarding SOD activation a notable difference has been noticed between the two groups (control: 894.34 ± 86.85 U/ml, study group: 415.43 ± 75.22 U/ml), and after 24 h a significant reduction has followed (p < 0.05) (Fig. 4).
Total superoxide dismutase activity was significantly lower during ischaemia versus control group, and decreased further in the 24th hour of reperfusion. Even, after a week could not reach the control value (∗∗p < 0.01 vs. control; ##p < 0.01 vs.ischaemia).
Plasma myeloperoxidase (MPO) level elevated significantly after revascularization, shows a slight decrease in 24 hours,than increase further in the late reperfusion period (∗∗p < 0.01; ∗∗∗p < 0.001 vs. control)..
The results show that the reperfusion induced, prompt oxidative stress does not disappear after the early period, but persist until the examined one week postoperative period. The basic pathology in the early reperfusion injury is the oxidative burst with the generation of a mass of oxygen free radicals.
The postischaemic, immediately oxidative turnover induces a massive inflammatory response with the activation of the leukocytes after 24 hours and in the late period these tissue inflammatory responses will maintain the oxidative imbalance.
Maximal free radical production of leukocytes was significantly higher during ischaemia (versus control), and continuously increased until the seventh day (*p < 0.05 and **\n\t\t\t\t\t\tp < 0.01 vs. control).
The “lag time” (taking from induction until the superoxide production) decreased significantly during the reperfusion This showed the significant activation of the leukocytes (#p < 0.05 vs. ischaemia*p < 0.05 and **p < 0.01 vs. control).
The long time monitoring of the oxidative and inflammatory changes in reperfusion helps to understand the pathology and to develop a more effective therapy.
During exclusion of blood from the circulation ischemia and acidosis appear in the surrounding tissues of the occluded vessels, which try to adapt to the absence of oxygen by switching their metabolism from aerobic to anaerobic, but finally these strategy will lead to tissue damage and loss. In the chronic or acute occlusive diseases the tissue injuries depend on the duration of hypoxia, the mass of tissues involved and the blood pressure of the patients. Reconstruction of the occluded vessels is not without risk, because it can cause volume, pressure and metabolic load, with further tissue damage resulting in the so-called reperfusion injury. Peripheral arterial diseases are a seriously under-diagnosed disorder affecting up to 20 % of the adult population worldwide. Atherosclerotic involvements frequently are in the background, thrombosis or embolization can occur within the narrowed or calcified vessels, or within the aneurismal sites, resulting in serious tissue ischemia.
It is very difficult to monitor the cellular processes, which influence the outcome of the surgical manoeuvres or serve as a marker of the following events. A huge amount of data emerged for the characterization of ischemia reperfusion injury, but function of thrombocytes has been hardly investigated by Kürthy M et al. In their study showed that the duration of hypoxia basicaIly influenced the degree of reperfusion injury in revascularization surgery, resulting in a different outcome in ADP and collagen induced platelet aggregation in whole blood even one week after surgery. Platelet aggregation highly and significantly elevated, in spite of the intensive antiplatelet and antiaggregation therapy. Sinay et al. measured in an in vivo animal model the serum total peroxide concentration during infrarenal aortic cross clamping ischaemia and reperfusion. Reperfusion injury is an integrated response to the restoration of blood flow after ischaemia, and is initiated at the very early moments of reperfusion, lasting potentially for days. The extent of the oxidative stress and the consecutive generalized inflammatory response depends on the ischaemic-time, the ischaemic tissue volume, and the general state of the endothelium-leukocyte-tissue functional complex (diabetes, chronic ischaemia, drugs). The pathogenesis of reperfusion injury is a complex process involving numerous mechanisms exerted in the intracellular and extracellular environments. Hypoxia leads to intracellular ATP depletion with a consecutive hypoxanthine elevation. In the early seconds of reperfusion, when the molecular oxygen appears in the cell, the – xanthine oxidase catalised –hypoxanthine–xanthine conversion will produce a mass of superoxide radicals. Superoxide radical and the other reactive oxygen intermediates will damage the membrane-lipids (through lipidperoxidation), the proteins (causing enzyme defects and ion channel injury) and the DNA. These are the main pathways of the cellular oxidant injury. The endogenous antioxidant system defends against these radical injuries.Reactive oxygen species (ROS) will also induce local and systematic inflammatory responses through the inducing of cytokine expression and leukocyte activation. Inflammatory process leads to increased microvascular permeability, interstitial edema, and capillary perfusion depletion. The oxidative and inflammatory pathways will lead to a complex reperfusion injury (Jancsó G,Fig.8).
Simplified presentation of the mechanism of ischaemic–reperfusion injury. Emphasizing, that the engine of reperfusion injury is the ROI–cytokine–leukocyte positive feedback circle (ROI: reactive oxygen intermediers; ATP: adenosine triphosphate; DNA: deoxyribonucleic acid).
The management of patients undergoing vascular surgery is one of the most challanging and contraversial area of anesthesiology. The high incidence of coexisting disease, the metabolic stress associated with cross-clamping and unclamping, the ischemic insults in the brain, the heart, the kidneys and the spinal cord resulting a relative high perioperative morbidity in these patients. While these pathways are well known in vascular surgery, there is no real effective tool in the hand of the operating team to treat or to prevent them. As we know how to limit ischemic damage (mostly by reducing the ischemia time via an early reperfusion, and improving O2 demand/supply balance), postconditioning might be the way to prevent or reduce reperfusion damage.
Postconditioning has the advantage of being a way to influence and modify ischaemia–reperfusion injury after it has occurred. This may open a therapeutic alternative in situations of unexpected and uncontrolled ischaemic injury, for instance in the situation where complications occur during surgery, making a simple procedure into a complicated one, and making aortic cross-clamping longer than anticipated.
Additive technologies are a breakthrough solution of this century. At the same time, when we speak about additive technologies, we generally mean the manufacturing of products of small sizes and irregular shapes. Large-sized products are still characterized by the use of traditional casting and forging shops. If mass production, such as the motor vehicle industry, is generally satisfied with traditional solutions, then small-scale manufacturing, such as the aircraft industry, requires a more advanced approach. A manufacturing cycle of relatively simple and large-sized products, such as longerons, frame elements, etc., may in certain cases take 2 years at a cost of 1.2 million dollars. The situation at hand is one of those reasons which result in unreasonably long terms and high costs of creation and introduction of new products to the market.
\nThe use of powder additive technologies sometimes gives rise to problems associated with low productivity of existing methods, high costs of equipment being used, limited types of materials, which is caused by the fact that powder systems melted by a powerful thermal source [1, 2, 3] are traditionally used as initial materials for additive formation of products. The formation of products from many aluminum alloys and active metal alloys, such as titanic and magnesium alloys, leads to increased porosity of materials of resulted products with considerably decreased mechanical properties [4, 5, 6, 7]. The productivity of formation of components from powder materials in traditional additive technologies is extremely low, which practically excludes any prospects of the use of these technologies for the purpose of manufacturing large-sized products.
\nHybrid manufacturing technologies combine the best characteristics of additive formation of workpieces and those of subsequent mechanical removal of materials in the course of creation of metal products [8, 9]. This process can be implemented on one platform with the hybrid layer-by-layer application of wire materials and the processing by CNC machines and is an optimum solution for the manufacturing of large-sized components of molds of low and average complexity.
\nOne of the first companies that is engaged in promoting wire material-related technologies is Sciaky (USA) [1, 2] that specializes in the development of electron-beam welding technologies and equipment. Additive manufacturing machines made by Sciaky produce components with the use of the layer-by-layer build-up welding method for materials in melts created by an electronic beam. This technology is known as EBDM (Electron Beam Direct Manufacturing). High performance levels (3–9 kg/h) demonstrated by the EBDM technology allow us to prepare components whose sizes are expressed in meters, which is impossible or extremely expensive when using any other additive technologies. This component formation principle is responsible for a low-quality surface of a synthesized component. However, the EBDM technology combined with traditional machining technologies allows us to obtain results with acceptable costs. Model materials used in this technology are additions (metal bars or wires), which is also an advantage as there are many available materials of this kind: nickel alloys, stainless and instrument steels, Co-Cr alloys and many others whose prices are considerably lower than those of these materials in their powdered condition [1]. Today, the company does not make standard machines and is generally involved in producing basic Sciaky’s DM models with the sizes of a formation zone of 5700 × 1200 × 1200 mm, and all modifications are created according to customer requirements. Machines allow to consistently form up to 10 various components in automatic mode and during one vacuumization cycle of a working chamber. The price of one machine is more than $2.0 million.
\nThe use of arc and plasma sources for the purpose of melting metal wire materials in the course of implementation of hybrid additive manufacturing technologies has been actively developed in recent years. In 2016, Norsk Titanium, a Norwegian start-up, attracted additional investments of 25 million dollars in order to certify materials resulted from the plasma layer-by-layer deposition with titanium wire and used to produce components for Boeing and Airbus aircrafts. It is also necessary to mention a company called WAAM (at Cranfield University) that is engaged in developing large-sized product formation technologies with the use of plasma technologies or consumable electrode surface welding processes with impulsive wire feeds and cold metal transfers (CMT) developed by Fronius. In the middle of 2016, Europe witnessed a 3-year LASSIM project with a budget of about 5 million euros that united 16 companies. The purpose of this project is to create a stand in order to implement several processes within a single space in the course of hybrid manufacturing of large-sized workpieces: additive manufacturing; multi-coordinate machining; layer-by-layer work hardening, measurement; non-destructive testing.
\nWhen modeling heat and mass transfer processes, it is necessary to consider that additive technologies are technologically closest to multi-layer deposition that also makes an initial material (filler wire) interact with a heat source, gradually builds up layers and superposes thermal cycles as and when new layers are added and transitional changes occur in the geometry. Temperature fields in a product to be processed are in most cases difficult to determine with the use of experimental methods. The most frequently used temperature measurement method consists in placing thermocouples directly next to the area of influence by a thermal source [10, 11, 12, 13]. Thermocouples can measure temperatures only in places where they are installed, and it is difficult to have a general picture of temperature distribution even when several thermocouples are used. Infrared thermography [14, 15, 16, 17] can measure only surface temperatures and cannot ensure the distribution of transient temperature processes in volume. The volume distribution of temperatures in a workpiece can be determined by mathematical modeling. However, the modeling of three-dimensional temperature fields is a rather demanding and complex problem due to accompanying difficult physical processes, their velocities, and many previously made calculations are connected with simplifications [18, 19, 20, 21].
\nIn order to model heat and mass transfer processes, we usually use the following equation system: mass, momentum and energy conservation equations [22, 23, 24, 25]. Solutions of these equations allow us to obtain temperature fields in all projections of a sample to be formed, melt flow rates, cooling rates and crystallization parameters that specify structures and properties of components. At the same time, information on computational temperature fields obtained by using adequate models allows us to predict microstructures and properties of workpieces resulted from different additive manufacturing methods.
\nThe process of manufacturing of components with the use of the additive manufacturing method is followed by complex thermo-mechanical phenomena resulting in the formation of technological residual stresses and possible contraction of components [26, 27, 28, 29, 30, 31, 32, 33]. The appearance of internal stresses in an object to be produced is connected with the essential spatiotemporal heterogeneous distribution of temperature and conversion fields.
\nA standard approach to the numerical solution of temperature deformations and residual stresses in additive manufacturing is to systematically and consistently analyze thermal conductivity in a transient mode and elastoplastic deformations [34]. Further, a transient heat conduction problem is firstly solved in a numerical manner; then, a temperature field is imported to a mechanical model as “thermal loads” in order to calculate stresses and deformations.
\nIn case of additive technologies with a rather small number of deposition passes, it is acceptable to thoroughly model each pass in the course of production of components [35, 36]. With this modeling method, the supply of heat brought by a thermal source is generally used as a volume thermal flow whose center moves along a deposition trajectory, thereby representing a moving source of heat. However, the additive formation of products usually has a large number of layers, which makes it unreasonable to model each separate pass in the course of creation of components. In order to make calculations more effective, we use a principle where successive melting steps and even layers are grouped together for subsequent simultaneous activation [37, 38]. This method provides that a stationary thermal flow is assigned to a discrete area for a period of time specified by users. It is obvious that the way of building-up of materials and of application of thermal loads in an individual manner is more correct, but requires higher computational efforts.
\nTherefore, the possibility of modeling of technological processes related to the layer-by-layer synthesis of products by multi-layer deposition of wire materials is a considerable reserve for the purposes of optimizing technological modes of production of components, developing control programs, minimizing defects and increasing manufacturing quality. At the same time, a lot of works are aimed at modeling selective laser melting or laser gas powder deposition welding processes. The modeling of arc methods of deposition welding of wire materials has specific features connected with a large volume of materials to be deposited and, as a result, with great possible deformations of products, as well as with specific aspects of the description of a thermal source [39].
\nGeneral variable parameters for mathematical models of heat and mass transfer processes with deposition welding with wire materials are as follows:
distribution of density of an energy flow of a heat source;
initial temperature of a sample;
distribution of an additional volume source (in case of additional induction heating);
dependence of thermophysical characteristics of materials on temperature;
characteristics of phase transitions;
velocity of a heat source;
orientation and feed rate of wire and its diameter.
As a part of the mathematical models described below, the following assumptions have been accepted:
In the process in question, the strength of a plasma arc, the feed rates of a support material Vн and wire Vп are constant or time intervals of their change considerably exceed a typical time of relaxation of temperature, velocity and concentration fields.
The ambient temperature is constant.
An energy source is characterized by Gaussian distribution of a thermal flow onto surfaces of a support material and a bed to be deposited.
Support and wire materials have the same chemical composition.
Molten metal is considered to be an incompressible Newtonian liquid whose physical parameters (density, viscosity, thermal conductivity, etc.) do not depend on temperature.
When describing thermal effects in the course of melting and hardening of materials, effective thermal capacity within a quasi-equilibrium model is used.
In order to describe the influence of a two-phase zone on the motion of a melt, Darcy term, representing the damping force when fluid passes through a porous media dendrite structures, is introduced to the motion equation [41].
An impact on the motion of a melt of electric and magnetic fields generated by a plasma flow is not considered.
Filler wires are fed into the zone of influence of a plasma arc, thereby causing a mass inflow. A plasma arc causes melting and evaporation of a filler material and a base material. The surface of a melt can be somehow deformed under the influence of the arc pressure, of falling droplets (when melting a wire) or of a local increase in metal vapors pressure.
\nTechnological process parameters affect the nature of a metal transfer to a melt. We can distinguish three typical modes:
Continuous metal transfer (Figure 1a). This mode is carried out at a low strength of a thermal source and is rather low-temperature. This mode slightly changes sizes and a form of cross section of a weld bed, as well as a structure and physical and mechanical properties of a metal to be deposited. This regime is optimal for the additive process. But their change may be caused only by disturbing factors (instable strength and position of a thermal source, deviation of a wire feed rate or displacement of a product, as well as influence of reheating zones). These factors are not considered at the current stage of works. A further decrease in energy to be delivered results in the fact that wires are melted only partially. This gives rise to formation defects and, therefore, this mode is not satisfactory.
A coarse-droplet transfer (Figure 1b) takes place when strength is increased above some critical value. The form of a weld bed and its cross dimensions range in length, metal splashes are present, and a crystallization process cannot be considered as a stationary one. This transfer mode may be acceptable for the consumable electrode welding technology. However, its use in most cases results in decreased quality when additive shape-forming processes are implemented.
A spray transfer (Figure 1c) is carried out in a mode with a higher energy of a thermal source. Metals being constantly fed experience a thermal influence sufficient for strong boiling. This mode is characterized by high spraying and uneven surfaces of weld beds to be formed.
Schematically illustrated modes of a mass transfer of a filler material to a melt [40]. a—Continuous metal transfer, b—coarse-droplet transfer and c—spray transfer. 1—Plasmotron; 2—plasma arc; 3—feeder; 4—wire; 5—wire feed direction; 6—product; 7—product motion direction; 8—weld bed being formed.
The geometry of a computational domain of the model in question is presented in a three-dimensional arrangement (Figure 2) and in the X-Z section (Figure 3). A surface source of a mass to be deposited onto a solid support material is fed to an interface at the velocity of Vп with some distribution in the X, Y plane (in case of a droplet transfer approximation is possible by Gaussian distribution). A thermal flow from an energy source is determined by Gaussian normal distribution. A minimum temperature in a source is supposed to be higher than the solidus temperature (TS). A mass source moves along a solid support material at the velocity of Vн (deposition welding velocity). There is the air above a solid support material.
\nGeometry of the computational domain.
Symmetric longitudinal section of the computational domain.
This problem is supposed to be tackled by the shock-capturing method where motion and temperature distribution equations are solved within the whole domain presented in Figure 2. In order to describe the motion of a material interface, the level set method is used. The position of an interface and values of material parameters of media (density, viscosity, thermal conductivity, thermal capacity) are determined according to a value of a special remote function ϕ, to which a separate equation is assigned. The level set method helps to determine an interface position between a metal (a molten metal) and the air. The position of a boundary of a phase transition between a solid metal and a melt is established according to a position of an isotherm corresponding to a melting temperature.
\nCourses in metal and in air are described by free thermal convection equations for incompressible media in Boussinesq approximation [42]:
\nwhere ρ—density, \n
where g—gravitational acceleration, β—thermal-expansion coefficient, T—absolute temperature, Tref—initial temperature taken as the solidus temperature (TS).
\nThe first equation member (2) represents thermo-gravitational convection, the second one does energy dissipation of in a two-phase zone (in the zone of a phase transition from a melt to a solid metal), according to the Kozeny-Carman equation where B—a small computational constant used to avoid division by zero, C—a constant reflecting the morphology of a two-phase zone (in these studies it is possible to use values around 104 … 106), fL—a function determining the position of a boundary between a liquid phase and a solid one in a metal (fusion zone boundary) [39]:
\nwhere TL and TS—liquidus temperature and solidus temperature.
\nThe third equation member (2) \n
The thermal energy distribution in the computational domain is described by means of the differential energy transfer equation:
\nwhere T—absolute temperature, \n
The approach in question provides that the location of a welding source of heat and a source of mass at the “metal-gas environment” interface are arbitrary functions of time. Besides, it is necessary to consider that a wire material is fed to the “metal-gas environment” interface in an already melted state, which also requires some part of energy [43]. In an approximation that the temperature of a melted wire material to be fed is equal to the temperature of a melt at the interface, thermal capacity Q to be brought in the Eq. (4) is expressed as follows:
\nwhere Q0—maximum thermal power in a source, r—radius of a thermal spot from a source, \n
The latent melting and crystallization heat was taken into consideration by introducing the effective thermal capacity:
\nwhere C0—thermal capacity depending on temperature, Hf—latent melting heat, Tmelt—melting temperature that is taken as an average one within a range from the solidus temperature to the liquidus one.
\nWhen in transition across the boundary of the interface of a liquid phase and a solid one in a metal, viscosity, first of all, suddenly changes from some final value \n
In calculations, \n
Surface forces are approximated as volume ones so that:
volume force \n
direction \n
value \n
in a limiting case, when a transitional layer turns into a jump in typical parameters of a liquid, the consideration of this volume force leads to an ordinary dynamic condition on the surface of an interface.
Based on the mentioned assumptions, an expression for the volume force is written as:
\nwhere \n
\n\n
The first addend in (8) describes capillary forces acting normally to the surface of the metal-air interface, the second addend describes thermo-capillary Marangoni forces acting tangentially to the surface where \n
where Ia—arc current, kI—electrodynamic constant.
\nIn the level set method, the position of an interface boundary is determined by a zero value of a level set or remote function ϕ. As for the remote function, we solve a transfer equation that will be as follows:
\nDensity, viscosity or concentration values are restored according to the remote function. For example, in case of density we have:
\nwhere \n
For numerical implementation, expression (13) is written as
\nThe delta function in expressions (5) and (8) is equal to
\nThe thickness of a transitional layer between the phases is equal to \n
Far from a fusion zone, at all boundaries of the computational domain, except for an upper boundary, a media velocity is supposed to be equal to zero. At the upper boundary, pressure is supposed to be set. For the remote function, at all boundaries the normal derivative is supposed to be equal to zero. Thermal conditions at the boundaries of the computational domain are determined by external technological conditions, but for model calculations all boundaries may be considered to be thermally insulated.
\nWhen modeling heat and mass transfer processes with the use of a plasma arc as a thermal source, there is a factor concerning the description of a thermal source, especially when using a plasma arc with current reverse polarity. A heat transfer to a product, under the influence of a plasma direct arc, is carried out by two mechanisms: convection from a plasma spray (a plasma flow) and heat emission in discharge (electrode) spots. Work [45] establishes that at an identical current and under all other conditions being equal a heat input to a product, during the operation of a plasmatron with current reverse polarity, is 1.3… 1.6 times higher than with current direct polarity, which is explained by a higher arc voltage. Unlike a constricted arc of direct polarity, a constricted arc of reverse polarity is characterized by a thermal power distributed more uniformly along the surface of a product (Figure 4).
\nChart of a heat transfer to a product at plasma processing. a—Current direct polarity, b—current reverse polarity. Рpf—Power delivered by convection by a plasma flow, Рas—power emitted at an anode spot, Рcs—power emitted in a cathode region, dpf—diameter of a plasma flow, das—diameter of an anode spot, dcs—diameter of a cathode region.
It should be noted that at plasma processing with a current of direct polarity values dpf and das are proportional, and it is impossible to control their size separately. The diameter of a plasma flow dpf is actually determined by the diameter of a nozzle dpf ≈ dn [46]. The distribution of density of a full thermal flow at direct polarity deposition welding is described by Gaussian distribution.
\nWith current reverse polarity, a plasma arc belongs to a type of arcs with non-stationary cathode spots traveling along the surface of a cathode. A travel width depends on the design of a plasmatron and the material of a product. One of distinctive features of non-stationary spots is their short-term existence and high current density (j∼105–106 A/m2), and local specific thermal flows in the area of short-term influence at a spot reach values (q∼106–107 W/cm2) (Figure 5). The time-averaged thermal influence of cathode spots can be approximated evenly by a thermal source distributed along the area restricted to dcs. The distribution of density of a thermal flow delivered by a plasma flow at reverse polarity deposition welding is described by Gaussian distribution. The diameter of a plasma flow dpf is supposed to be the diameter of a nozzle dcs ≈ dn [46]. For the deposition of metal during the layer-wise formation, the following equipment which has been developed at Perm National Research Polytechnic University was used: the plasma welding unit BPS-350; universal plasmatron PM1-15.
\nAspects of a heat transfer to a product during the operation of a plasmotron with a current of reverse polarity. qcs—Density of a thermal flow from a non-stationary cathode spot, q—density of a resulting thermal flow, d—diameter of the influence of a thermal flow, h—fusion depth of a base.
A value dcs under the influence of an arc with current reverse polarity, can be actively controlled.
\nThe size of a cathode region depends on parameters of a technological mode and requires determination. The travel of cathode spots leads to a known phenomenon of cathode cleaning under the influence of an electric arc of reverse polarity [47] on the surface of metals. It is generally believed [48] that the destruction and removal of an oxide film from a product surface in the area of influence of a reverse polarity arc result from attacking the surface of a metal by positive ions.
\nWhen a plasmatron operates with a reverse polarity current on a surface subjected to cathode cleaning, there is a visible mark [49] that allows us to visually estimate the area of traveling of cathode spots (Figure 6).
\nTraveling of cathode spots along a product surface during the operation of a reverse polarity plasmotron.
A phenomenon of cathode cleaning can be used to create a statistical dependence of the influence of technological parameters of reverse polarity plasma arcs on the diameter of a cathode region. At the first stage, it is possible to use an empirical model [48].
\nwhere Ia—arc current, Qpg—protective gas consumption (l/min), Qp—plasma-forming gas consumption (l/min), V—plasmatron displacement speed, m/h, H—plasmatron nozzle height above a product (mm).
\nTherefore, a plasma source at reverse polarity deposition welding is represented by a combination of a source of heat delivered by a plasma flow with Gaussian distribution, of diameter dpf, and an evenly distributed source of diameter dcs. An energy ratio between these sources is determined experimentally according to the method suggested in the work [50].
\nIn order to analyze the applicability of selected approaches, the preliminary numerical implementation in the two-dimensional statement of a problem of melting of wire materials with concentrated and arc energy sources was carried out. A Comsol 4.4 application software package (Heat Transfer, Level Set and Laminar Flow modules) was used. The geometry of the computational domain is presented in Figure 7.
\nGeometry of the computational domain.
The sizes of the computational domain are 50 mm (length) and 10 mm (height). A process simulation area was covered with a two-dimensional grid included in the computational domain. The grid had an even pitch. The size of a cell was 0.3 mm.
\nA 304-L stainless steel was accepted as a model material. The stainless steel workpiece had a composition of 18.2% Cr, 8.16% Ni, 1.71% Mn, 0.02% C, 0.082% N, 0.47% Mo, 0.44% Si, 0.14% Co, 0.35% Cu, 0.0004% S, 0.03% P, and balance Fe. Many thermophysical characteristics of materials are functions of temperature [51, 52, 53, 54]. At this stage, these nonlinearities were not taken into consideration. Table 1 specifies accepted values that were used in calculations. Parameters of the deposition welding mode presented in Table 2. As boundary conditions for a model example all boundaries, except for a lower one, were taken as thermally insulated. At the lower boundary, a constant temperature of 273 K was maintained.
\nAttribute | \nDesignation | \nSize | \nValue | \n
---|---|---|---|
Liquidus temperature | \nTS | \n[K] | \n1723 | \n
Solidus temperature | \nTL | \n[K] | \n1673 | \n
Specific heat capacity | \nC | \n[J·kg−1·K−1] | \n500 | \n
Density | \nρ | \n[kg·m−3] | \n7000 | \n
Thermal conductivity | \nλ | \n[W·m−1·K−1] | \n28.9 | \n
Specific melting heat | \nHf | \nkJ/kg | \n84 | \n
Source strength, W | \nSource displacement velocity, mm/s | \nWire feed rate, mm/s | \n
---|---|---|
800 | \n5 | \n15 | \n
Deposition mode parameters.
Figure 8 shows the distribution of temperature in a sample to be deposited 2 s later after the beginning of a process. A melt area is marked by a line.
\nDistribution of temperature in the course of deposition welding.
The deposition welding results obtained upon completion of a 4-s process are given in Figure 9. This model appropriately helps to determine distributions of temperatures, melt flow rates, pressures, components of heat flow densities, forms and sizes of weld beds to be deposited.
\nWeld bed formation results.
The process of manufacturing of components with the use of the additive manufacturing method is followed by complex thermo-mechanical phenomena resulting in the formation of technological residual stresses and possible contraction of components [28, 30, 31, 32, 55, 56, 57, 58]. The appearance of internal stresses in an object to be produced is connected with the essential spatiotemporal heterogeneous distribution of temperature and conversion fields. The appearance of residual stresses is caused due to the fact that inelastic deformations [33] are not consistent, first of all, temperature shrinkage deformations at cooling, structural shrinkage due to the course of phase transformations (melt crystallization) that is notable for a deformation history of various material points because of heterogeneous temperatures, temperature gradients and temperature velocities.
\nIn most cases, such measures as preliminary natural validations of technologies, selection of certain locations of components, selection of technological modes, are taken in order to eliminate and minimize any geometrical defects arising in the course of manufacturing of modern components, which is a serious obstacle to organizing comprehensive digital manufacturing processes.
\nAn approach associated with creating and using mathematical and computer models of thermomechanical behaviors of components in the course of additive manufacturing allows us not to carry out natural experiments at a stage of design of technological process parameters and structural parameters and to predict qualitative and quantitative characteristics of stress conditions and contractions of future components, as well as study the effectiveness of possible measures aimed at decreasing residual stresses and deformations (heat treatment).
\nCalculation of residual stresses and warpage for the wire fusion process remains the most difficult aspect in numerical simulation. Often, the addition of material is modeled by adding and (or) activating new elements to previously placed ones. The growth of new elements adds additional rigidity to the existing structure and requires the gradual addition of more and more new elements to the solution area. There are three most commonly used methods of modeling material deposition—the so-called birth element (1), a quiet element (2) and hybrid activation (3) [59, 60]. In the method of the birth element, the elements for the material that has not yet been created are deactivated (and thus not included in the solution area), and then gradually regenerated and included in the solution area. In the method of sleeping elements, all elements are present in the calculation model from the very beginning and have artificial properties with very low rigidity. As the details grow, the properties of these elements gradually switch to real physical properties. Finally, the hybrid activation method combines the methods of emerging and sleeping elements, where only the current deposition layer is activated and set to a sleeping state, and all subsequent layers are deactivated [60].
\nFor products with a relatively small number of surfacing passages, detailed modeling of each passage in the construction of a part is permissible [35, 36]. With this method of modeling, the heat input from the beam energy is usually applied as a volumetric heat flux whose center moves along the trajectory of surfacing, thus representing a moving heat source. Such a method with a moving heat source was used to model both Directed Energy Deposition (DED) [36] and Powder Bed Fusion (PBF) [35] additive production processes. Nevertheless, usually the product has a large number of layers, which makes it impractical to simulate each individual passage when creating a part. To ensure greater efficiency of calculations, the principle is used, in which the successive melting steps and even the layers are grouped together for subsequent simultaneous activation [37, 38].
\nWe know studies aimed at modeling additive manufacturing processes, optimizing thermal cycles, estimating the influence of process parameters on changes in forms of finished products [59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80].
\nA large volume of research has been published for PBF from various materials, ranging from stainless steel [19, 63, 64, 65], carbon steels [78, 79, 80], nickel alloys [69, 70, 71, 72, 73, 74, 75] and titanium alloy Ti-6Al-4V [34, 69, 70, 71, 72, 75, 76]. By modeling residual stresses and deformations for additive technologies using wire, much less work has been published than for powder systems. The normalized maximum residual stress is presented in [19, 64] as a function of the power, scanning speed, and preheating of the substrate in the construction of a thin-walled structure. In [64] 3D sequential temperature and elastic calculations were performed using the COMSOL and MATLAB packages. In [65], a 3D sequential temperature and elastic-plastic analysis was performed in the SYSWELD package. In works [66, 67] the ABAQUS is used for sequential temperature and elastic-plastic 3D analysis, deformation due to a phase transition is taken into account. In [62, 73], the COMET program and element activation technology are used, a thermo-elasto-viscoplastic material model is used. Additive technology Wire Arc Additive Manufacturing (WAAM) is suitable for manufacturing parts that require a large amount of surfacing [69, 72, 77]. In [69, 70, 71, 72] for WAAM technology in ABAQUS software, 3D analysis is performed, assuming the elastic-plastic behavior of the material.
\nTo improve the efficiency of the calculations, Li et al. [78] proposed a method that displays the local residual stress field calculated at the mesoscale level for the rapid prediction of warping of a part. Another approach to efficient modeling warping is to use the inherent-strain method, developed by Yuan and Ueda to calculate the deformation in welding large-sized parts [79]. The method directly applies a known proper (initial) deformation to calculate buckling and does not require a numerical solution of non-stationary temperature and elastoplastic problems in a step-by-step formulation. Finally, Mukherjee et al. [71, 75] constructed an analytical expression for the special deformation parameter for estimating the maximum residual strains as a function of the linear heat release, substrate stiffness, maximum temperature, the thermal expansion coefficient of the fusion alloy and the Fourier number, which expresses the ratio between the speed changes in the thermal conditions in the environment and the speed of the adjustment of the temperature field inside the system under consideration.
\nThe numerical modeling of residual stresses and thermoshrinkable deformations at additive formation of products with the use of wire materials melted by a plasma arc is considered below.
\nIn view of small deformations and negligibly small dissipative heat emission, it is possible to divide a boundary problem of non-stationary thermal conductivity and a boundary problem of thermomechanics with regard to a stressed-deformed state that are unrelated in such statement. Death and birth technologies (Elements Birth and Death in ANSYS) with regard to material parts (originally absent in a model and then added in the course of deposition) can be used in order to solve them. At the same time, an area occupied by an already finished product is considered as a computational one. The continuous building-up of a material is carried out discretely, at each substage of calculation corresponding to the “birth” of a next subarea from “dead” elements, a boundary problem of heat conductivity and thermomechanics is solved, and a result of solution of a previous substage serves as initial conditions for a subsequent one.
\nAt substage \n
Thermal conductivity equation:
\nwhere \n
Boundary conditions:
\nwhere the first addend of a right part describes a convective heat transfer, and the second one—radiation (the Stefan-Boltzmann law); the third one—radiation from a plasmatron nozzle, \n
Initial conditions:
\nwhere \n
These relations consider that an area of study \n
\n\n
An unrelated quasistatic boundary problem of mechanics of a deformable solid body, taking into account the insignificance of a contribution of mass forces at substage \n
Equilibrium equations:
\nwhere \n
Cauchy geometrical relations:
\nwhere \n
Displacement boundary conditions:
\nStress boundary conditions:
\nwhere \n
Thermomechanical properties of the material in the area of “dead” elements exclude physical nonlinearity and are perfectly elastic with degraded values:
\nwhere \n
The general equation system of the deformable solid body mechanics boundary value problem includes constitutive relations as well. To describe the viscoelastoplastic behavior of the alloy under study, we used the Anand [84] model included to the list of ANSYS physical models. The model has the following form:
\nwhere \n
where \n
The model also includes the evolutionary equation:
\nThe equation involves a possibility of work hardening and work softening. The designations are as follows:
\n\n\n
Taking into account behavior characteristics of the elements activated according to the technology used at ANSYS, the formulas (25) are transposed to the following form:
\nwhere \n
As the setup of the mechanical problem (Eqs. (21)–(28)) imply, the ANSYS system of hypotheses does not include separation of the stress tensor into any components. The input of separate factors to the stress field generation is covered by the corresponding deformation types (see the formula (25)). At that, shrinkage due to phase transformation is covered by temperature deformation with the help of corresponding adjustment of the thermal coefficient of linear expansion within the solidus-liquidus interval.
\nThe algorithm of calculations of temperature fields in numerical simulation of the plasma deposition process in the finite element ANSYS package stipulates performance of the following computational procedures:
To create the finite element model including volumes to be occupied by the product divided to separate horizontal layers as well as the platform—the basis with suitable thermal and physical properties.
To “kill” (the EKILL command) a part of the elements that are not involved in the real process of building up before its beginning.
In the cycle of layer building up beginning from the bottom layer:
To define conditions of convective heat exchange at the upper boundary of the layer according to the formula (19).
In the cycle of sub-steps of passing the deposition areas of the successive computational layer:
To remove a part of the layer at its bottom boundary under the area of previously defined conditions of convective heat exchange where available.
To activate (the EALIVE command) all elements of the \n
To heat a part of the area’s elements distributed around the volume using a thermal energy source (see the formula (18)) for a time of plasma arc impact. \n
To remove the heat source and wait for the holding time \n
To wait until the system cools down completely (partially). Solution of a non-stationary problem with known boundary conditions for a thermo-mechanical model, all of whose elements are active.
The impact time of the plasma arc \n
where \n
The holding time \n
where \n
The specific capacity of heat emission on the surface of the heated spot of the deposited material is defined according to the following formula:
\nwhere \n
The specific volumetric capacity of the heat source used in the Eq. (18) has the following form:
\nwhere \n
The discrete model of the computational domain is similar to the model of the heat conductivity problem above. Before calculation, the Solid279 heat element is replaced with Solid286, which uses displacements as the degrees of freedom, and thermomechanical properties are added. The algorithm is similar to that of Item 4.1.:
To “kill” (the EKILL command) a part of the elements that are not involved in the real process of building up before its beginning. To define boundary conditions in displacement (e.g. fixation along the cutting plane, vertical fixation in entrapment zones etc.).
In the cycle of layer building up beginning from the bottom layer:
In the cycle of sub-steps of passing the deposition areas of the successive computational layer:
To activate (the EALIVE command) all elements of the \n
To implement temperatures, previously calculated for that moment of time, to the units of the model for the impact time of the ray \n
To implement temperatures, previously calculated for the end moment of the holding time, and hold for \n
To read the temperature field for the period of partially cooldown of the system, to calculate SSS.
To implement the ambient temperature, to release the entrapment, to calculate SSS.
After that we performed preliminary verification of the mathematical model and numerical algorithm for solution of the three-dimensional problem of metal products manufacturing using plasma deposition of wire materials. For the reference we took the results of the experiment for wire deposition on a metal base using arc surfacing in shielding gases with a tungsten (nonconsumable) electrode as described in the Article [85]. Figure 10a shows the plate in question with the dimensions of 275 х 100 х 12 mm. We build up a metal rib with the length of 165 mm and the cross section showed in Figure 10b on the upper surface of the object.
\nProduct view illustration after the experiment with fixation and sensor systems (a), dimensions of the deposited area at the cross section, mm (b) [85].
The arc deposition process is performed in 2 steps. The first step involves preliminary heating of the base plate that is performed by torch back and forth movement with the speed of \n
Figure 11 shows the finite element model of the problem. 20-unit isoparametric Solid 279 elements were used for solution.
\nThe discrete model of the building up problem.
The Inconel 718 nickel alloy was used as the material for calculation [86].
\nThermal and physical properties of the material were taken from the Article [87]. In addition to the above, according to the data, represented in the Article, the density \n
Dependence of the enthalpy H(T), kJ/kg, from the temperature T, К, for the alloy Inconel 718.
Identification of the chosen Anand model (25)–(28) for the material under study was performed according to the data of the stretch experiment with the defined speed at different temperatures represented in the Article [87].
\nThe required constants of the model were defined in several steps by the downhill simplex method in the Matlab package. At that, relative disparity of computational and experimental values of voltage in Diagram \n
Comparison of experimental (dots) and computational values of voltage in unconfined stretch tests at the temperatures of 720, 850, 900, 1150°С (top-down).
As the result, the following values of material constants were obtained by the authors of this publication:
\n\n\n
Figure 13 shows that relative error of the calculation does not exceed 10%. The material was considered as isotropic. The Young’s modulus of elasticity and the Poisson ratio were equal to 153 GPa and 0.32 respectively and not dependent on temperature [80]. The average value of CLTE at the temperature range up to the solidus temperature \n
The main results of the calculations were given in [88]. Verification was performed using the experimental results obtained in the paper [86, 87]. Figure 14 shows the layout of temperature sensors in the investigational studies mentioned above.
\nThe layout of temperature sensors.
In this case sensors No. 2, 3, 5, 6 were placed on the upper surface of the base plate, and No. 1 and 4 were placed on its bottom surface. Initial direction of the torch movement is from right to left. Figures 15–17 show graphs of temperature evolution at the given points.
\nThe temperature, °С in points 1 (red lined) and 4 (black lines). Thin curves show the experiment, thick curves show the calculation.
The temperature, °С in points 2 (red lined) and 6 (black lines). Thin curves—the experiment, thick curves—the calculation.
The temperature, °С in points 3 (red lined) and 5 (black lines). Thin curves—the experiment, thick curves—the calculation.
The figures show that the qualitatively retrieved data comply with the experiment. The worst quantitative match is observed at points on the down plane of the base close to the heating area (points 1 and 4, Figure 15). In addition, the curves have oscillations and the temperature is below the ambient temperature at some points. All in all, the experimental graphs are below the computational graphs. The oscillations can be explained by proximity of the heating area and, consequently, heavy temperature gradients substantially altering the result at a fairly coarse mesh. Higher heating level in the experiment may be also caused by failure to take account of the torch heat radiation expanded far beyond the computational size of the spot.
\nPrecision of the computational data is substantially higher at other measurement points (Figures 16 and 17). The maximum absolute disparity does not exceed 25°С.
\nFigure 18 shows by way of illustration the temperature fields at the moment of the end of preliminary heating of the base plate (Figure 18a) and of the end of the fourth layer (Figure 18b).
\nTemperature distribution, K (a) \n\nt\n=\n291\n\ns\n\n, (b) \n\nt\n=\n506\n\ns\n\n.
Figure 19 shows the results of solution of the deformable body mechanics problem and residual displacement at central cross sections of the plate. The figure shows that the residual contraction of the structure can be estimated with acceptable accuracy. It was predicted that the plate will be bowl-shaped with the height of the ribs about 1 mm. The minimum computational accuracy is at the cross section where the relative disparity of the height runs up to 20%.
\nRelative residual displacement, mm, at longitudinal (blue lines) and cross (black lines) sections of the plate on its bottom surface. Thin curves show the experiment, thick curves show the calculation.
Figure 20 represents the distribution pattern of residual characteristics in the structure.
\nVertical displacement in the structure after its cooldown and release, m (a), residual stress intensity, Pa (b).
Figure 20a shows that the longitudinal bend dominates. The transverse bend is almost 10 times lower. The maximum intensity of residual stresses is observed at the contact area of the deposited material and the base.
\nThe stresses are calculated at every step of solution of the quasipermanent boundary deformable solid body problem (Eqs. (21)–(28)). Figure 20b represents distribution of residual stresses, i.e. the stresses observed in the structure at the end of the production process and complete cooldown to the ambient temperature.
\nThe model of thermomechanical behavior of the sample, created by the additive fabrication method, is designed for evaluation of strain-stress state of the sample and its contraction as well as for definition of parameters of the production process ensuring low contraction and residual stress. The model can be combined with other mathematical and numerical models including the temperature and conversion model specifying distribution of the variable temperature field inside the sample.
\nThe model may be included into a computer-aided expert system to forecast the results of additive fabrication of large-sized components.
\n\n
We defined the mathematical problem (model) of heat and mass transfer in the process of additive fabrication of products by fusion of wire material using plasma (electric) arc and concentrated energy sources with asymmetrical wire feed. The model describes transient nonequilibrium adjoint heat and mass transfer processes in molten metal with free surface, includes differential equation of viscous fluid movement (Navier-Stokes equations) with convective terms in laminar current, takes into account the Marangoni effect on the surface of melt, and allows to calculate volume distribution of temperatures, melt flow speed, pressure, shape and dimensions of the molten pool, shape of the molten metal free surface, shape and dimensions of the deposited bead. We also defined potential uses of the models.
We suggested approximation of the wire feed process by mass inflow on the metal-gas edge. To describe movement of the molten-solid metal interface, one can use any of the two following methods: the Level-Set method or the Arbitrary Lagrangian-Eulerian method (ALE).
We described the heat source when using a plasma arc of various electrical polarity. In the process of deposition with reverse polarity, the plasma source is represented by a combination of the source of the heat, transferred by the plasma flow, with Gaussian distribution and a uniformly distributed source in the area of cathode spots impact. The energy relation between the sources is defined by experiment. We preselected the approximating formulas which describe influence of technological parameters of plasma arcs on distribution of heat flow density in the source.
We suggested the mathematical 3D-model of the additive product fabrication process by deposition of wire material.
We developed and implemented in the form of an APDL program in the ANSYS package the algorithm for estimation of unsteady temperature fields and strain-stress state of the structure in the process of its generation by arc 3D-deposition of wire materials.
The experimental information of other authors was used to identify the thermal-physical and thermomechanical properties of the material—the Inconel 718 nickel alloy.
Verification of the model showed required accuracy of the results.
The represented example of application of the model and its numerical implementation in the ANSYS package shows that the chosen approach is reasonable and allows to obtain acceptable numerical results properly describing real effects and processes in the objects created by the method of additive volume generation. More accurate verification procedure for the suggested mathematical model showing its accuracy and limits of applicability on the basis of experimental studies of residual stresses and thermoshrinkable deformations of model products manufacturing using the method of additive part fabrication by fusion of wire material with an electric arc and concentrated energy sources will be represented in future studies.
The work was supported by the Ministry of Education and Science of the Russian Federation (RFMEFI58317X0062) and MOST (No. 2017YFE0100100) under the BRICS project.
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