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Wang Z, Fang C, Song H, Wei D, Meng X, Bai X, Liu C, Zhao X. Endovascular repair of thoracic aortic disease with isolated left vertebral artery and unfavorable proximal landing zone using fenestrated castor stent-graft. Front Cardiovasc Med 2023; 10:1168180. [PMID: 37692046 PMCID: PMC10483811 DOI: 10.3389/fcvm.2023.1168180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/11/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The main purpose of this study was to evaluate the safety and efficacy of Castor single-branched stent-graft combined with fenestrated technique in treatment of thoracic aortic disease (TAD) with unfavorable proximal landing area (PLZ) and isolated left vertebral artery (ILVA). Methods From January 2018 to March 2022, 8 patients with TAD (6 patients with type B aortic dissections, 1 patient with type B intramural hematomas, and 1 patient with thoracic aortic aneurysm) underwent thoracic endovascular aortic repair with fenestrated Castor stent-graft due to the existence of ILVA and unfavorable PLZ. Demographic characteristics, surgical details, postoperative complications, follow-up and postoperative CTA imaging results were collected and analyzed. Results The primary technical success rate was 100%. The mean operation time was 115 min (range, 70-180 min). All the left subclavian arteries (LSAs) and ILVAs of the eight patients were revascularized by fenestrated Castor stent-grafts. During the follow-up period, no deaths and complications were observed. No internal leakage, aortic rupture, retrograde type A dissection were found on computed tomography angiography. All of the LSAs and ILVAs maintained patency without stenosis. Conclusion Castor single-branched stent-graft implantation combined with fenestration technique may be safe and feasible for TAD patients with ILVA and unfavorable PLZ.
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Affiliation(s)
- Zhenhua Wang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Changcun Fang
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Han Song
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Duoliang Wei
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Xiangbin Meng
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Xiao Bai
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Chunxiao Liu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
| | - Xin Zhao
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Institute of Thoracoscopy in Cardiac Surgery, Shandong University
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Wang J, Fan T, Zhang H, Ge Y, Lu W, Liu F, Rong D, Guo W. Aortic hemodynamic and morphological analysis before and after repair of thoracoabdominal aortic aneurysm using a G-Branch endograft. Front Physiol 2023; 14:1234989. [PMID: 37601633 PMCID: PMC10438984 DOI: 10.3389/fphys.2023.1234989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background and objective: The G-Branch endograft is a novel multibranched "off-the-shelf" device used to repair thoracoabdominal aortic aneurysms (TAAAs). This report describes the hemodynamic and morphological performance of the G-Branch endograft in a human patient with TAAA. Materials and methods: We retrospectively reviewed the computed tomography angiography scans and clinical data of a woman in whom TAAA was treated using a G-Branch endograft. Patient-specific three-dimensional models were reconstructed, and computational fluid dynamics and morphological and hemodynamic indicators were analyzed before and after implantation of the device. Results: From a morphological perspective, there was an increase in cross-sectional area in the G-Branch endograft and all bridging stent grafts over time. Blood flow was redistributed among the renovisceral arteries, with a decrease in flow rate in the celiac artery and an increase in the left renal artery. Laminar blood flow was smoother and more rapid after implantation of the G-Branch device and remained stable during follow-up. In the bridging stent grafts, flow recirculation zones were found in the bridging zones of the celiac artery and superior mesenteric artery as well as the distal sealing zones of both renal arteries. Furthermore, higher time-averaged wall shear stress and a lower oscillatory index and relative resident time were found in the G-Branch endograft and bridging stent grafts. Quantitative analysis showed obvious reduction in the surface area ratio of the elevated time-averaged wall shear stress area and surface area ratio of the relative resident time after G-branch implantation. Conclusion: The revascularization of branch vessels occurred following G-branch implantation, with improvements arising not only from morphological changes but also from hemodynamic alterations. The long-term performance of the G-Branch endograft needs further investigation and clinical validation.
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Affiliation(s)
- Jiabin Wang
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Tingting Fan
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Hongpeng Zhang
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yangyang Ge
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Weihang Lu
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Feng Liu
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Dan Rong
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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Li F, Zhu Y, Song H, Zhang H, Chen L, Guo W. Analysis of Postoperative Remodeling Characteristics after Modular Inner Branched Stent-Graft Treatment of Aortic Arch Pathologies Using Computational Fluid Dynamics. Bioengineering (Basel) 2023; 10:bioengineering10020164. [PMID: 36829658 PMCID: PMC9952632 DOI: 10.3390/bioengineering10020164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/14/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
The modular inner branched stent-graft (MIBSG), a novel interventional therapy, has demonstrated good effects in the endovascular treatment of aortic arch pathologies, especially those involving the supra-aortic branches. Nevertheless, the long-term efficacy of the MIBSG and in-depth quantitative evaluation of postoperative outcomes remain to be examined. Moreover, the regularity of postoperative vascular remodeling induced by MIBSG implantation has yet to be explored. To address these questions, we constructed four models (normal, preoperative, 1 week postoperative, and 6 months postoperative) based on a single patient case to perform computational fluid dynamics simulations. The morphological and hemodynamic characteristics, including the velocity profile, flow rate distribution, and hemodynamic parameter distribution (wall shear stress and its derivative parameters), were investigated. After MIBSG implantation, the morphology of the supra-aortic branches changed significantly, and the branch point moved forward to the proximal ascending aorta. Moreover, the curvature radius of the aortic arch axis continued to change. These changes in morphology altered the characteristics of the flow field and wall shear stress distribution. As a result, the local forces exerted on the vessel wall by the blood led to vessel remodeling. This study provides insight into the vascular remodeling process after MIBSG implantation, which occurs as a result of the interplay between vascular morphological characteristics and blood flow characteristics.
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Affiliation(s)
- Fen Li
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- Institute of Applied Mechanics, Taiyuan University of Technology, Taiyuan 030024, China
| | - Yating Zhu
- First Medical Center of Chinese PLA General Hospital, Department of Vascular Surgery, Beijing 100853, China
| | - Hui Song
- College of Mechanical and Vehicle Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- Institute of Applied Mechanics, Taiyuan University of Technology, Taiyuan 030024, China
| | - Hongpeng Zhang
- First Medical Center of Chinese PLA General Hospital, Department of Vascular Surgery, Beijing 100853, China
| | - Lingfeng Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
- Correspondence: (L.C.); (W.G.)
| | - Wei Guo
- First Medical Center of Chinese PLA General Hospital, Department of Vascular Surgery, Beijing 100853, China
- Correspondence: (L.C.); (W.G.)
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Ling Y, Schenkel T, Tang J, Liu H. Computational fluid dynamics investigation on aortic hemodynamics in double aortic arch before and after ligation surgery. J Biomech 2022; 141:111231. [PMID: 35901663 DOI: 10.1016/j.jbiomech.2022.111231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 02/08/2023]
Abstract
Double aortic arch (DAA) malformation is one of the reasons for symptomatic vascular rings, the hemodynamics of which is still poorly understood. This study aims to investigate the blood flow characteristics in patient-specific double aortic arches using computational fluid dynamics (CFD). Seven cases of infantile patients with DAA were collected and their computed tomography images were used to reconstruct 3D computational models. A modified Carreau model was used to consider the non-Newtonian effect of blood and a three-element Windkessel model taking the effect of the age of patients into account was applied to reproduce physiological pressure waveforms. Numerical results show that blood flow distribution and energy loss of DAA depends on relative sizes of the two aortic arches and their angles with the ascending aorta. Ligation of either aortic arch increases the energy loss of blood in the DAA, leading to the increase in cardiac workload. Generally, the rising rate of energy loss before and after the surgery is almost linear with the area ratio between the aortic arch without ligation and the ascending aorta.
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Affiliation(s)
- Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu 610065, China
| | - Torsten Schenkel
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield S1 1WB, United Kingdom
| | - Jiguo Tang
- State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu 610065, China.
| | - Hongtao Liu
- State Key Laboratory of Hydraulics and Mountain River Engineering, College of Water Resource & Hydropower, Sichuan University, Chengdu 610065, China
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Hu J, Li F, Qiu P, Wu X, Pu H, Zhao Z, Qin J, Liu G, Jin S, Lu X, Liu X. Clinical Validation of the Impact of Branch Stent Extension on Hemodynamics in ISF-TEVAR Involving LSA Reconstruction. Front Cardiovasc Med 2022; 9:911934. [PMID: 35770224 PMCID: PMC9234204 DOI: 10.3389/fcvm.2022.911934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe study of hemodynamics regarding thoracic endovascular aortic repair (TEVAR) is helpful to improve the surgical efficacy.ObjectiveCorrelations between hemodynamic changes and branch stent extension length and interference factors for branch stent extension length of in situ fenestration TEVAR (ISF-TEVAR) involving the left subclavian artery (LSA) were evaluated.Materials and MethodsThis study retrospectively analyzed 196 patients with Stanford type B aortic dissection who received in situ laser fenestrated thoracic endovascular aortic repair with LSA fenestration from April 2014 to March 2021. Branch stent extension to the main stent graft was evaluated by the computed tomographic angiography (CTA). Hemodynamic change of LSA was defined as a 20 mmHg interbrachial systolic pressure difference. The factors affecting the extension of the branch stent were also evaluated.ResultsAll patients underwent ISF-TEVAR with LSA fenestration, and there was no recurrence during the follow-up. The mean length of the branch stent extension was 10.37 ± 0.34 mm, which was used to divide the patients into long and short groups. Asymptomatic hemodynamic changes (defined as a 20 mmHg interbrachial systolic pressure difference) in LSA were observed in 61 patients undergoing ISF-TEVAR involving LSA fenestration. The Spearman correlation analysis showed extension length of a branch stent >1.5 cm elevated the risk of hemodynamic changes.ConclusionOverall, we conclude that branch stent extension length >1.5 cm induced LSA hemodynamic changes. Appropriate shortening of the stent extension length can improve the curative effect of ISF-TEVAR, especially when faced with a type II/III aortic arch and stent angles of <30 degrees.
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Affiliation(s)
- Jiateng Hu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Fengshi Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Peng Qiu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Zhao
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Guang Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
| | - Shanliang Jin
- Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Shanliang Jin
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
- Xinwu Lu
| | - Xiaobing Liu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Vascular Centre of Shanghai Jiao Tong University, Shanghai, China
- Xiaobing Liu
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Qiao Y, Luo K, Fan J. Component quantification of aortic blood flow energy loss using computational fluid-structure interaction hemodynamics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106826. [PMID: 35526507 DOI: 10.1016/j.cmpb.2022.106826] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES The aorta serves as the main tube of the human blood circulation system. Energy loss (EL) occurs when blood flows through the aorta and there may be a potential correlation between EL and aortic diseases. However, the components of blood flow EL are still not fully understood. This study aims to quantitatively reveal the EL components in healthy and diseased aortas. METHODS We construct an idealized healthy aorta and three idealized representative diseased aortas: aortic aneurysm, coarctation of the aorta, and aortic dissection. Computational hemodynamic studies are carried out by using the fluid-structure interaction simulation framework. RESULTS Four kinds of EL components: viscous friction, turbulence dissipation, wall deformation, and local lesion are firstly acquired in healthy and diseased aortas based on the high-resolution blood flow information. Viscous friction contributes most to the EL (45.69%-57.22%). EL caused by the deformation of the aortic wall ranks second (15.18%-33.12%). The proportions of turbulence dissipation and local lesion depend on individual geometric characteristics. Besides, the buffering efficiency of the healthy and diseased aorta is about 80%. CONCLUSIONS This study quantitatively reports the components of blood flow EL in healthy and diseased aortas, the finding may provide novel insights into the pathogenesis of aortic diseases.
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Affiliation(s)
- Yonghui Qiao
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, 38 Zheda Road, Hangzhou 310027, China
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, 38 Zheda Road, Hangzhou 310027, China; Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China.
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, 38 Zheda Road, Hangzhou 310027, China; Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China
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Haemodynamic Analysis of Branched Endografts for Complex Aortic Arch Repair. Bioengineering (Basel) 2022; 9:bioengineering9020045. [PMID: 35200399 PMCID: PMC8868591 DOI: 10.3390/bioengineering9020045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
This study aims to investigate the haemodynamic response induced by implantation of a double-branched endograft used in thoracic endovascular aortic repair (TEVAR) of the aortic arch. Anatomically realistic models were reconstructed from CT images obtained from patients who underwent TEVAR using the RelayPlus double-branched endograft implanted in the aortic arch. Two cases (Patient 1, Patient 2) were included here, both patients presented with type A aortic dissection before TEVAR. To examine the influence of inner tunnel branch diameters on localised flow patterns, three tunnel branch diameters were tested using the geometric model reconstructed for Patient 1. Pulsatile blood flow through the models was simulated by numerically solving the Navier–Stokes equations along with a transitional flow model. The physiological boundary conditions were imposed at the model inlet and outlets, while the wall was assumed to be rigid. Our simulation results showed that the double-branched endograft allowed for the sufficient perfusion of blood to the supra-aortic branches and restored flow patterns expected in normal aortas. The diameter of tunnel branches in the device plays a crucial role in the development of flow downstream of the branches and thus must be selected carefully based on the overall geometry of the vessel. Given the importance of wall shear stress in vascular remodelling and thrombus formation, longitudinal studies should be performed in the future in order to elucidate the role of tunnel branch diameters in long-term patency of the supra-aortic branches following TEVAR with the double-branched endograft.
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Qiao Y, Mao L, Wang Y, Luan J, Chen Y, Zhu T, Luo K, Fan J. Hemodynamic effects of stent-graft introducer sheath during thoracic endovascular aortic repair. Biomech Model Mechanobiol 2022; 21:419-431. [PMID: 34994871 DOI: 10.1007/s10237-021-01542-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/26/2021] [Indexed: 12/19/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has become the standard treatment of a variety of aortic pathologies. The objective of this study is to evaluate the hemodynamic effects of stent-graft introducer sheath during TEVAR. Three idealized representative diseased aortas were designed: aortic aneurysm, coarctation of the aorta, and aortic dissection. Computational fluid dynamics studies were performed in the above idealized aortic geometries. An introducer sheath routinely used in the clinic was virtually placed into diseased aortas. Comparative analysis was carried out to evaluate the hemodynamic effects of the introducer sheath. Results show that the blood flow to the supra-aortic branches would increase above 9% due to the obstruction of the introducer sheath. The region exposed to high endothelial cell activation potential (ECAP) expands in the scenarios of coarctation of the aorta and aortic dissection, which indicates that the probability of thrombus formation may increase during TEVAR. The pressure magnitude in peak systole shows an obvious rise, and a similar phenomenon is not observed in early diastole. The blood viscosity in the aortic arch and descending aorta is remarkably altered by the introducer sheath. The uneven viscosity distribution confirms the necessity of using non-Newtonian models, and high-viscosity region with high ECAP further promotes thrombosis. Our results highlight the hemodynamic effects of stent-graft introducer sheath during TEVAR, which may associate with perioperative complications.
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Affiliation(s)
- Yonghui Qiao
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Wang
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Jingyang Luan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanlu Chen
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China. .,Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China.
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China. .,Shanghai Institute for Advanced Study of Zhejiang University, Shanghai, China.
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Qiao Y, Mao L, Ding Y, Zhu T, Luo K, Fan J. Fluid-structure interaction: Insights into biomechanical implications of endograft after thoracic endovascular aortic repair. Comput Biol Med 2021; 138:104882. [PMID: 34600328 DOI: 10.1016/j.compbiomed.2021.104882] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/04/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has developed to be the most effective treatment for aortic diseases. This study aims to evaluate the biomechanical implications of the implanted endograft after TEVAR. We present a novel image-based, patient-specific, fluid-structure computational framework. The geometries of blood, endograft, and aortic wall were reconstructed based on clinical images. Patient-specific measurement data was collected to determine the parameters of the three-element Windkessel. We designed three postoperative scenarios with rigid wall assumption, blood-wall interaction, blood-endograft-wall interplay, respectively, where a two-way fluid-structure interaction (FSI) method was applied to predict the deformation of the composite stent-wall. Computational results were validated with Doppler ultrasound data. Results show that the rigid wall assumption fails to predict the waveforms of blood outflow and energy loss (EL). The complete storage and release process of blood flow energy, which consists of four phases is captured by the FSI method. The endograft implantation would weaken the buffer function of the aorta and reduce mean EL by 19.1%. The closed curve area of wall pressure and aortic volume could indicate the EL caused by the interaction between blood flow and wall deformation, which accounts for 68.8% of the total EL. Both the FSI and endograft have a slight effect on wall shear stress-related-indices. The deformability of the composite stent-wall region is remarkably limited by the endograft. Our results highlight the importance of considering the interaction between blood flow, the implanted endograft, and the aortic wall to acquire physiologically accurate hemodynamics in post-TEVAR computational studies and the deformation of the aortic wall is responsible for the major EL of the blood flow.
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Affiliation(s)
- Yonghui Qiao
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China
| | - Le Mao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Zhu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kun Luo
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.
| | - Jianren Fan
- State Key Laboratory of Clean Energy Utilization, Zhejiang University, Hangzhou, China.
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