Aortic Hemodynamics After Thoracic Endovascular Aortic Repair, With Particular Attention to the Bird-Beak Configuration

作者：van Bogerijen Guido H W; Auricchio Ferdinando; Conti Michele; Lefieux Adrien; Reali Alessandro; Veneziani Alessandro; Tolenaar Jip L; Moll Frans L; Rampoldi Vincenzo; Trimarchi Santi^*

来源：Journal of Endovascular Therapy, 2014, 21(6): 791-802.

DOI：10.1583/14-4778MR.1

• computational fluid dynamics
• biomechanics
• aorta
• thoracic endovascular aortic repair
• bird-beak
• stent-graft
• flow disturbance
• true lumen narrowing

Purpose: To quantitatively evaluate the impact of thoracic endovascular aortic repair (TEVAR) on aortic hemodynamics, focusing on the implications of a bird-beak configuration. %26lt;br%26gt;Methods: Pre- and postoperative CTA images from a patient treated with TEVAR for post-dissecting thoracic aortic aneurysm were used to evaluate the anatomical changes induced by the stent-graft and to generate the computational network essential for computational fluid dynamics (CFD) analysis. These analyses focused on the bird-beak configuration, flow distribution into the supra-aortic branches, and narrowing of the distal descending thoracic aorta. Three different CFD analyses (A: preoperative lumen, B: postoperative lumen, and C: postoperative lumen computed without stenosis) were compared at 3 time points during the cardiac cycle (maximum acceleration of blood flow, systolic peak, and maximum deceleration of blood flow). %26lt;br%26gt;Results: Postoperatively, disturbance of flow was reduced at the bird-beak location due to boundary conditions and change of geometry after TEVAR. Stent-graft protrusion with partial coverage of the origin of the left subclavian artery produced a disturbance of flow in this vessel. Strong velocity increase and flow disturbance were found at the aortic narrowing in the descending thoracic aorta when comparing B and C, while no effect was seen on aortic arch hemodynamics. %26lt;br%26gt;Conclusion: CFD may help physicians to understand aortic hemodynamic changes after TEVAR, including the change in aortic arch geometry, the effects of a bird-beak configuration, the supra-aortic flow distribution, and the aortic true lumen dynamics. This study is the first step in establishing a computational framework that, when completed with patient-specific data, will allow us to study thoracic aortic pathologies and their endovascular management.

• 出版日期2014-12