The genesis of atherosclerosis has previously been shown to be affected by the frictional load from the blood on the vessel wall, called the wall shear stress (WSS). Assessment of WSS can therefore provide important information for diagnoses, intervention planning, and follow‐up. Calculation of WSS requires high‐resolved velocity data from the vessel, which in turn can be obtained using computational fluid dynamics (CFD). In this work large eddy simulation LES was successfully used to simulate transitional flow in idealized as well as subject specific vessel models. It was shown that a scale resolving technique is to prefer for this application, since much valuable information otherwise is lost. Besides, Reynolds‐Averaged Navier‐Stokes (RANS) models have generally failed to predict this type of flow.

Non‐pulsating flows of Reynolds numbers up to 2 000 in a circular constricted pipe showed that turbulence is likely to occur in the post‐stenotic region, which resulted in a complex WSS pattern characterized by large spatial as well temporal fluctuations in all directions along the wall. Time averaged streamwise WSS was relatively high, while time averaged circumferential WSS was low, meaning that endothelial cells in that region would be exposed to oscillations in a stretched state in the streamwise direction and in a relaxed state in the circumferential direction.

Since every vessel is unique, so is also its WSS pattern. Hence the CFD simulations must be done in subject specific vessel models. Such can be created from anatomical information acquired with magnetic resonance imaging (MRI). MRI can also be used to obtain velocity boundary conditions for the simulation. This technique was used to investigate pulsating flow in a subject specific normal human aorta. It was shown that even the flow in healthy vessels can be very disturbed and turbulence like, and even for this case large WSS variations were seen. It was also shown that regions around branches from the aorta, known to be susceptible for atherosclerosis, were characterized by high time averaged WSS and high oscillatory shear index.

Finally, the predictive capability of CFD was investigated. An idealized model of a human aorta with a coarctation and post‐stenotic dilatation was studied before and after a possible repair of the constriction. The results suggested that small remaining abnormalities in the geometry may deteriorate the chances for a successful treatment. Also, high values of shear rate and Reynolds stresses were found in the dilatation after the constriction, which previous works have shown means increased risk for thrombus formation and hemolysis.