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

Theodorus M. van Bakel; Rodrigo M. Romarowski; Simone Morganti; Joost A. van Herwaarden; Frans L. Moll; Hector W. de Beaufort; Massimiliano M. Marrocco-Trischitta; Francesco Secchi; Michele Conti; Ferdinando Auricchio; Santi Trimarchi

doi:10.1055/s-0039-1683771

AORTA, Inhaltsverzeichnis

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

Authors

Theodorus M. van Bakel

¹Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy

²Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
Rodrigo M. Romarowski

¹Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy

³Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
Simone Morganti

³Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
Joost A. van Herwaarden

²Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
Frans L. Moll

²Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
Hector W. de Beaufort

¹Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy

²Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
Massimiliano M. Marrocco-Trischitta

¹Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy
Francesco Secchi

⁴Department of Radiology, IRCCS—Policlinico San Donato, San Donato Milanese, Italy
Michele Conti

³Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
Ferdinando Auricchio

³Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
Santi Trimarchi

¹Thoracic Aortic Research Center, IRCCS—Policlinico San Donato, University of Milan, Milan, Italy

⁵Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

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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Referenzen

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