Endovascular treatment for chronic type B aortic dissection: current opinions

Tommaso, Luigi Di; Giordano, Raffaele; Tommaso, Ettorino Di; Iannelli, Gabriele

doi:10.21037/jtd.2018.03.145

Cited by 8 publications

(2 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Conventional open surgery is currently reserved for chronic patients with anatomy unsuitable for endovascular treatment or patients with connective tissue diseases. Open repair is required in about 30% of patients with complicated chronic type B aortic dissection and is associated with higher procedural morbidity and mortality 61 .…”

Section: Ad Type Amentioning

confidence: 99%

Development of a Bioresorbable Patch to Treat Aortic Dissection

Balà¹,

Martorell²,

Borrós³

et al. 2023

Journal of Vascular Surgery

View full text Add to dashboard Cite

Section: Ad Type Amentioning

confidence: 99%

Development of a Bioresorbable Patch to Treat Aortic Dissection

Balà¹,

Martorell²,

Borrós³

et al. 2023

Journal of Vascular Surgery

View full text Add to dashboard Cite

“…In a systematic review of 19 studies, it was found that the overall mortality rate for type B aortic dissection open surgery is 11.1%, which is reduced to 7.5% in the endovascular era [5]. However, OS is necessary in about 30% of cases when the chronic dissection is complicated and not amenable to endovascular treatment or in the case of connective tissue disorders that compromise graft landing zones [6]. Indeed, complications such as pulmonary collapse, renal failure or malperfusion leading to ischemia may develop in the acute or chronic stages, requiring immediate surgery.…”

Section: Introductionmentioning

confidence: 99%

Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch

Girardin

Stokes

Thet

et al. 2023

Preprint

View full text Add to dashboard Cite

IntroductionCompliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations.Materials and MethodsA post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow Magnetic Resonance Imaging (2DMRI) data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed.ResultsIncreased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively.ConclusionThis study highlights the negative impact of increased graft length on LV condition after surgical aortic replacement in TBAD. To mitigate the associated risks to the patient, graft manufacturers should allocate more resources toward developing compliant biomimetic grafts.

show abstract

Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch

Girardin,

Stokes,

Thet

et al. 2024

Cardiovasc Eng Tech

View full text Add to dashboard Cite

Introduction Compliance mismatch between the aortic wall and Dacron Grafts is a clinical problem concerning aortic haemodynamics and morphological degeneration. The aortic stiffness introduced by grafts can lead to an increased left ventricular (LV) afterload. This study quantifies the impact of compliance mismatch by virtually testing different Type-B aortic dissection (TBAD) surgical grafting strategies in patient-specific, compliant computational fluid dynamics (CFD) simulations. Materials and Methods A post-operative case of TBAD was segmented from computed tomography angiography data. Three virtual surgeries were generated using different grafts; two additional cases with compliant grafts were assessed. Compliant CFD simulations were performed using a patient-specific inlet flow rate and three-element Windkessel outlet boundary conditions informed by 2D-Flow MRI data. The wall compliance was calibrated using Cine-MRI images. Pressure, wall shear stress (WSS) indices and energy loss (EL) were computed. Results Increased aortic stiffness and longer grafts increased aortic pressure and EL. Implementing a compliant graft matching the aortic compliance of the patient reduced the pulse pressure by 11% and EL by 4%. The endothelial cell activation potential (ECAP) differed the most within the aneurysm, where the maximum percentage difference between the reference case and the mid (MDA) and complete (CDA) descending aorta replacements increased by 16% and 20%, respectively. Conclusion This study suggests that by minimising graft length and matching its compliance to the native aorta whilst aligning with surgical requirements, the risk of LV hypertrophy may be reduced. This provides evidence that compliance-matching grafts may enhance patient outcomes.

show abstract

Endovascular treatment for chronic type B aortic dissection: current opinions

Cited by 8 publications

References 25 publications

Development of a Bioresorbable Patch to Treat Aortic Dissection

Development of a Bioresorbable Patch to Treat Aortic Dissection

Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch

Patient-Specific Haemodynamic Analysis of Virtual Grafting Strategies in Type-B Aortic Dissection: Impact of Compliance Mismatch

Contact Info

Product

Resources

About