Physiologic Blood Flow is Turbulent: Revisiting the Principles of Vascular Hemodynamics

Contemporary paradigm of vascular hemodynamics considers normal blood flow to be pulsatile laminar flow. Transition to turbulence can cause diseases such as atherosclerosis or brain aneurysms. Recently, we demonstrated the existence of turbulence in experimental models of brain aneurysm; in the aneurysm sac as well as in the main artery. Thus, we were intrigued to explore if such a long-standing assumption of the laminarity of blood flow could be challenged. We have used methods and tools from chaos theory, hydrodynamic stability theory and turbulence physics to explore the existence of turbulence in normal vascular blood flow. We used Womersley exact solution of the Navier-Stokes equation with the HaeMed database of physiologic blood flow measurements, to offer reproducible evidence for our findings, as well as evidence from Doppler ultrasound measurements from healthy volunteers. The tools we used to investigate the properties of blood turbulence are well established in the fields of chaos theory, hydrodynamic stability and turbulence dynamics. We show, evidently, that blood flow is inherently chaotic and turbulent and not laminar. We propose a paradigm shift in the theory of vascular hemodynamics which requires rethinking the hemodynamic-biologic links governing physiologic and pathologic processes.