Hemodynamic and Anatomic Predictors of Renovisceral Stent-Graft Occlusion Following Chimney Endovascular Repair of Juxtarenal Aortic Aneurysms

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

doi:10.1177/1526602817731096

Cited by 21 publications

(14 citation statements)

References 41 publications

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“…CFD simulations. Using a previously published modelling algorithms, 17,18 haemodynamics were simulated by numerically solving the continuity and NaviereStokes momentum equations for a pulsatile blood flow using ANSYS Fluent. Patient specific velocity profiles, derived from Doppler ultrasound imaging were adopted as outlet boundary conditions of the bilateral common carotid, subclavian, and vertebral arteries.…”

Section: Computational Modelling Frameworkmentioning

confidence: 99%

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

Tricarico

Tran‐Son‐Tay

Laquian

et al. 2020

European Journal of Vascular and Endovascular Surgery

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WHAT THIS PAPER ADDS Technologies allowing endografting in the aortic arch are in active clinical trials with various configurations of branch stent graft design. A systematic computational fluid dynamic analysis was carried out to quantitatively evaluate the haemodynamic characteristics of stenting within the left subclavian artery (LSA). The results showed that a shorter extension of the LSA branch stent graft into the aortic lumen up to 5 mm has a smaller risk of potential thrombus generation; a longer extension could lead to thrombus formation impacting outcomes. These findings may help optimise the deployment and design of the stent graft system for treating aortic pathologies involving arch branches. Objective: Branched stent grafts represent a viable option for left subclavian artery (LSA) revascularisation in patients treated by thoracic endovascular aortic repair (TEVAR) for Zone 2 lesions. This study investigated the haemodynamic performance of different LSA branched stent graft configurations as potential determinants of thrombotic and stroke risks. Methods: A three dimensional aortic arch geometry extracted from post-operative computed tomography images of a TEVAR patient using a single LSA branched aortic endograft was modified in silico to obtain ten potential LSA branched stent graft configurations: five down facing (0e5 e 10 mm aortic protrusion with 10e12 mm internal diameter), four curved (30e60 with antegrade/retrograde orientation), and one LSA orifice misalignment. The 0 mm down facing stent graft was considered base configuration. Computational fluid dynamic analyses were performed to identify differences in pressure, energy, and wall shear stress (WSS) based parameters. Results: Total pressure drop and energy loss variations among configurations were not greater than 5 mmHg (6% of mean arterial pressure) and 5.7 mW (0.7% of cardiac power), respectively. Protrusions up to 5 mm created clinically insignificant flow disturbances. However, stent graft protrusions further into the aortic lumen created more complex haemodynamics, characterised by larger energy loss and more prominent flow recirculation. Protrusion greater than 5 mm into the lumen was associated with larger areas of elevated maximum WSS (>20 Pa) along the outer surface of the branched stent graft. Conclusion: Arterial haemodynamic characteristics are affected by LSA branched stent graft configurations, with pressure drops and energy losses likely to be clinically insignificant. The length of the stent graft protrusion into the aortic lumen generated the largest haemodynamic variations in the aortic system. Protrusions up to 5 mm have smaller risk of potential thrombus generation. Conversely, larger protrusions into the aortic lumen showed more disturbed haemodynamics, suggesting a greater risk of potential thrombus formation, which may be clinically important over time.

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Section: Computational Modelling Frameworkmentioning

confidence: 99%

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

Tricarico

Tran‐Son‐Tay

Laquian

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…Given the patency of the branch, the stent graft is inapplicable because important branches, such as the renal artery, mesenteric artery, and hepatic artery, are blocked while the aneurysm is excluded. Although the chimney 8–11 and fenestrated techniques 12–15 are commonly used in the management of aneurysms with visceral vessels, these stents usually require customization because of individual differences, and the process of surgery is difficult and intricate for clinicians in terms of precise deployment. Therefore, a more convenient scheme is required.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Performance of Multilayer Stents in the Treatment of Aneurysms with a Branch Attached

Hu²,

Chen

et al. 2019

Sci Rep

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Although multilayer stents (MSs) can be used to treat aneurysm effectively, for some aneurysms with branches attached, the hemodynamic mechanisms are still unclear. In this work, we modeled five cases that involve 1–4-layer stents implanted in aneurysms with side branches, and the numerical approach was used. Case 1 corresponds to an aneurysm without a stent, and cases 2–5 represent 1–4-layer stents being employed within aneurysms, respectively. The results showed that the velocity within the sac declined dramatically and the eddies’ intensity weakened with increased number of stent layers, time-averaged wall shear stress (TAWSS), and nitric oxide production rate (TAR NO ) dropped linearly with increase in stent porosity, and oscillatory shear index (OSI) and relative residence time (RRT) increased evidently with MS intervention. Moreover, the MSs had a slight effect on the patency of the side branch; its flow rate was still above the normal case than without aneurysm. It can be concluded that MSs are helpful in promoting the growth of thrombus within the aneurysm through an isolated hemodynamic environment and keeping the branch unobstructed, but more clinical evidences are required.

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“…Moreover, a multivariate analysis of chimney endovascular aneurysm repair shows that occlusion rates increase with small target vessels, 9 such as in this LCCA chimney case, in which the chimney stent graft might have been undersized and contributed to its failure. In our previous publication, 12 we examined a series of juxtarenal endovascular aneurysm repairs to identify specific geometric and hemodynamic parameters that are associated with chimney stent graft occlusion. We believe that similar parameters may be beneficial in predicting future failure; however, the number of available aortic arch cases is currently insufficient to develop validated parameters for such predictions.…”

Section: Discussionmentioning

confidence: 99%

“…The hemodynamics were simulated in ANSYS Fluent software (ANSYS Inc, Canonsburg, Pa) under rigid wall conditions. Flow was assumed to be laminar and pulsatile; additional details of CFD simulations and the methodology of parameter extraction have been reported previously 12, 13. Distribution of total pressure and wall shear stress (WSS)-related parameters are presented in this study.…”

Section: Methodsmentioning

confidence: 99%

Anatomic and hemodynamic investigation of an occluded common carotid chimney stent graft for hybrid thoracic aortic aneurysm repair

Tricarico

Tran‐Son‐Tay

et al. 2019

Journal of Vascular Surgery Cases, Innovations and Techniques

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We examined the possible reasons for common carotid artery chimney stent graft occlusion through computational fluid dynamics analyses of follow-up imaging of a patient-specific aortic configuration reconstructed from computed tomography aortography. Anatomic and hemodynamic parameters were extracted for the bilateral common carotid and subclavian arteries before and after endograft placement. Results suggested that postoperative reduction in lumen diameter within the chimney stent graft combined with an increased flow rate led to complex hemodynamics with high wall shear stress, probably resulting in high-shear thrombogenesis and chimney stent graft occlusion 2.6 years after the primary repair. Early postoperative duplex ultrasound imaging might help identify at-risk conditions.

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Hemodynamic and Anatomic Predictors of Renovisceral Stent-Graft Occlusion Following Chimney Endovascular Repair of Juxtarenal Aortic Aneurysms

Abstract: Chimney stent-grafts at increased risk for occlusion demonstrated anatomic and hemodynamic signatures within 1 month of juxtarenal chEVAR. Analysis of these parameters in the early postoperative period may be useful for identifying and remediating these high-risk stent-grafts.

Cited by 21 publications

References 41 publications

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

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

Hemodynamic Performance of Multilayer Stents in the Treatment of Aneurysms with a Branch Attached

Anatomic and hemodynamic investigation of an occluded common carotid chimney stent graft for hybrid thoracic aortic aneurysm repair

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