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CC BY 4.0 · Aorta (Stamford) 2018; 06(03): 081-087
DOI: 10.1055/s-0039-1683771
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Blood Flow after Endovascular Repair in the Aortic Arch: A Computational Analysis

Theodorus M. van Bakel
1   Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
2   Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Rodrigo M. Romarowski
1   Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
3   Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
,
Simone Morganti
3   Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
,
Joost A. van Herwaarden
2   Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Frans L. Moll
2   Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Hector W. de Beaufort
1   Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
2   Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
,
Massimiliano M. Marrocco-Trischitta
1   Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
,
Francesco Secchi
4   Department of Radiology, IRCCS—Policlinico San Donato, San Donato Milanese, Italy
,
Michele Conti
3   Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
,
Ferdinando Auricchio
3   Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
,
Santi Trimarchi
1   Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
5   Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
› Author Affiliations Funding None.
Further Information

Publication History

24 May 2017

05 November 2018

Publication Date:
22 February 2019 (online)

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Abstract

Background The benefits of thoracic endovascular aortic repair (TEVAR) have encouraged stent graft deployment more proximally in the aortic arch. This study quantifies the hemodynamic impact of TEVAR in proximal landing zone 2 on the thoracic aorta and the proximal supra-aortic branches.

Methods Patients treated with TEVAR in proximal landing zone 2 having available preoperative and 30-day postoperative computer tomography angiography and phase-contrast magnetic resonance imaging data were retrospectively selected. Blood flow was studied using patient-specific computational fluid dynamics simulations.

Results Four patients were included. Following TEVAR in proximal landing zone 2, the mean flow in the left common carotid artery (LCCA) increased almost threefold, from 0.21 (0.12–0.41) L/min to 0.61 (0.24–1.08) L/min (+294%). The surface area of the LCCA had not yet increased commensurately and therefore maximum flow velocity in the LCCA increased from 44.9 (27.0–89.3) cm/s to 72.6 (40.8–135.0) cm/s (+62%). One of the patients presented with Type Ib endoleak at 1-year follow-up. The displacement force in this patient measured 32.1 N and was directed dorsocranial, perpendicular to the distal sealing zone. There was a linear correlation between the surface area of the stent graft and the resulting displacement force (p = 0.04).

Conclusion TEVAR in proximal landing zone 2 alters blood flow in the supra-aortic branches, resulting in increased flow with high flow velocities in the LCCA. High displacement forces were calculated and related to stent graft migration and Type I endoleak during 1-year follow-up.

Keywords

thoracic endovascular aortic repair - blood flow - displacement force
 

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