Haemodynamics of Different Configurations of a Left Subclavian Artery Stent Graft for Thoracic Endovascular Aortic Repair

Tricarico, Rosamaria; Tran‐Son‐Tay, Roger; Laquian, Liza; Scali, Salvatore T.; Lee, Teng-Chun; Beck, Adam W.; Berceli, Scott A.; He, Yong

doi:10.1016/j.ejvs.2019.06.028

Cited by 17 publications

(10 citation statements)

References 27 publications

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“…The feature that distinguishes this IBD from other IBDs is the embedded branch design. Some studies had proposed the protrusion configuration in thoracic stent grafts and renal stent grafts to maintain branch perfusion ( 22 , 27 ). The embedded configuration can reduce the limitations related to the diameter of the CIA by eliminating the integral branch opening.…”

Section: Discussionmentioning

confidence: 99%

In-vitro and In-silico Haemodynamic Analyses of a Novel Embedded Iliac Branch Device

Liang

Jia

Zhang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundIliac branch devices (IBDs) are valid tools for internal iliac artery preservation during endovascular abdominal aortic aneurysm and iliac aneurysm repair. The purpose of this study was to evaluate the effectiveness of a novel IBD with an embedded branch configuration.MethodA typical iliac artery model was reconstructed, and two models were manufactured using three-dimensional printing technology. The novel IBD was deployed into one iliac artery model by an experienced vascular surgeon. A mock circulation loop (MCL) and a computational fluid dynamics (CFD) simulation were used to investigate the haemodynamic parameters of the iliac models without (Model A) and with (Model B) the IBD. A morphological analysis was conducted using computed tomography angiography and medical endoscopy. The flow distribution rate (FDR) and energy loss (EL) were used to quantify IBD performance.ResultsThe FDR of the right internal iliac artery in the MCL of Model A and Model B was 18.88 ± 0.12% and 16.26 ± 0.09%, respectively (P = 0.0013). The FDR of the right internal iliac artery in the CFD simulation of Model A and Model B was 17.52 and 14.49%, respectively. The EL of Model A was greater than Model B in both the MCL and the CFD simulation. Compared with Model A, Model B had a larger region (8.46 vs. 3.64%) with a relative residence time of >20 Pa−1 at peak systole. Meanwhile, the area where the oscillatory flow index was >0.4 was significantly smaller in Model B than in Model A (0.46 vs. 0.043%). The region with an average wall shear stress of >4 Pa was greater in Model B than in Model A (0 vs. 0.22%).ConclusionThe MCL and CFD simulation showed that the novel IBD had little impact on the FDR and EL of the iliac artery models. However, the IBD might be an effective tool for the treatment of abdominal aortic/iliac aneurysms that extend into branches. Further investigations are warranted to confirm whether this IBD could be useful in the clinic.

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Section: Discussionmentioning

confidence: 99%

In-vitro and In-silico Haemodynamic Analyses of a Novel Embedded Iliac Branch Device

Liang

Jia

Zhang

et al. 2022

Front. Cardiovasc. Med.

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“…However, compared to the lower extremity, the stent-graft implanted in the visceral arteries were relatively steady to the lumbar vertebra, which may produce less helix flow rotation. Therefore, we used the established parameter-oscillatory shear index (19,35) instead of helicity to address the turbulence in the endovascular aortic repair. In our results, the flow characteristics of TAWSS, OSI, and RRT were consistent in the non-thrombotic areas, whereas hemodynamic alteration appeared solely in the IST area.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Parameters Predict In-stent Thrombosis After Multibranched Endovascular Repair of Complex Abdominal Aortic Aneurysms: A Retrospective Study of Branched Stent-Graft Thrombosis

Liu

Yang

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Branch vessel occlusion is reported in endovascular repair of aortic pathology. This study aimed to evaluate the hemodynamic indicators associated with in-stent thrombosis (IST) of a branched stent-graft (BSG) after endovascular aortic repair (EVAR) of a complex abdominal aortic aneurysm.Methods: A retrospective evaluation was performed based on the computed tomography (CT) scans and clinical data of three patients who underwent multi-branched endovascular repair. Patient-specific 3-dimensional models were reconstructed, and hemodynamic analysis was performed for IST. Hemodynamics-related parameters including time-averaged wall shear stress (TAWSS), oscillatory shear stress index (OSI), and relative residence time (RRT) were compared among the individual patients.Results: The flow velocity, TAWSS, OSI, and RRT were radically changed in the area of the IST. In BSGs, IST tended to occur in the regions of hemodynamic alteration near the bends in the device, where a decreased flow velocity (<0.6 m/s) and TAWSS (<0.8 Pa) and an elevated OSI (>0.2) and RRT (>5 s) were consistently observed.Conclusions: Hemodynamic perturbations in BSGs cause a predisposition to IST, which can be predicted by a series of changes in the flow parameters. Early hemodynamic analysis might be useful for identifying and remediating IST after multibranched endovascular repair.

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“…The blood flow was assumed to be laminar, in keeping with other studies in the field. 6 , 12 , 37 Additionally, the flow was assumed to be incompressible and the blood non-Newtonian with density = 1060 kg/m 8 and dynamic viscosity described by the Carreau-Yasuda model: where denotes the scalar shear rate. The shear viscosity at low shear rates, = 0.16, the shear viscosity at large shear rates, = 0.0035 and material coefficients and were equal to 8.2 s and 0.2128 respectively, following common values found in the literature.…”

Section: Methodsmentioning

confidence: 99%

Section: Cfdmentioning

confidence: 99%

Efficiently Simulating an Endograft Deployment: A Methodology for Detailed CFD Analyses

et al. 2020

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Numerical models of endografts for the simulation of endovascular aneurysm repair are increasingly important in the improvement of device designs and patient outcomes. Nevertheless, current finite element analysis (FEA) models of complete endograft devices come at a high computational cost, requiring days of runtime, therefore restricting their applicability. In the current study, an efficient FEA model of the Anaconda™ endograft (Terumo Aortic, UK) was developed, able to yield results in just over 4 h, an order of magnitude less than similar models found in the literature. The model was used to replicate a physical device that was deployed in a 3D printed aorta and comparison of the two shapes illustrated a less than 5 mm placement error of the model in the regions of interest, consistent with other more computationally intensive models in the literature. Furthermore, the final goal of the study was to utilize the deployed fabric model in a hemodynamic analysis that would incorporate realistic fabric folds, a feature that is almost always omitted in similar simulations. By successfully exporting the deployed graft geometry into a flow analysis, it was illustrated that the inclusion of fabric wrinkles enabled clinically significant flow patterns such as flow stagnation and recirculation to be detected, paving the way for this modelling methodology to be used in future for stent design optimisation.

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Haemodynamics of Different Configurations of a Left Subclavian Artery Stent Graft for Thoracic Endovascular Aortic Repair

Cited by 17 publications

References 27 publications

In-vitro and In-silico Haemodynamic Analyses of a Novel Embedded Iliac Branch Device

In-vitro and In-silico Haemodynamic Analyses of a Novel Embedded Iliac Branch Device

Hemodynamic Parameters Predict In-stent Thrombosis After Multibranched Endovascular Repair of Complex Abdominal Aortic Aneurysms: A Retrospective Study of Branched Stent-Graft Thrombosis

Efficiently Simulating an Endograft Deployment: A Methodology for Detailed CFD Analyses

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