Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups

Xu, Huanming; Li, Zhenfeng; Dong, Huiwu; Zhang, Yilun; Ji, Wei; Watton, Paul N.; Guo, Wei; Chen, Duanduan; Xiong, Jiang

doi:10.1016/j.medengphy.2017.08.011

Cited by 45 publications

(53 citation statements)

References 35 publications

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“…The correct assessment of WSSbased indices in these regions of the FL can have important prognostic value. For example, as recently reported by Xu et al [28], the short-term variation of the Relative Residence Time (RRT), which is based on TAWSS and OSI (RRT = [(1-2⋅OSI)⋅TAWSS] -1 ), might be related to the post-TEVAR long-term FL remodelling.…”

Section: Aortic Dissection Case Studymentioning

confidence: 79%

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A simplified method to account for wall motion in patient-specific blood flow simulations of aortic dissection: Comparison with fluid-structure interaction

Bonfanti

Balabani

Alimohammadi

et al. 2018

Medical Engineering & Physics

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Aortic dissection (AD) is a complex and highly patient-specific vascular condition difficult to treat. Computational fluid dynamics (CFD) can aid the medical management of this pathology, yet its modelling and simulation are challenging. One aspect usually disregarded when modelling AD is the motion of the vessel wall, which has been shown to significantly impact simulation results. Fluid-structure interaction (FSI) methods are difficult to implement and are subject to assumptions regarding the mechanical properties of the vessel wall, which cannot be retrieved non-invasively. This paper presents a simplified 'moving-boundary method' (MBM) to account for the motion of the vessel wall in type-B AD CFD simulations, which can be tuned with non-invasive clinical images (e.g. 2D cine-MRI). The method is firstly validated against the 1D solution of flow through an elastic straight tube; it is then applied to a type-B AD case study and the results are compared to a state-of-the-art, full FSI simulation. Results show that the proposed method can capture the main effects due to the wall motion on the flow field: the average relative difference between flow and pressure waves obtained with the FSI and MBM simulations was less than 1.8% and 1.3%, respectively and the wall shear stress indices were found to have a similar distribution. Moreover, compared to FSI, MBM has the advantage to be less computationally expensive (requiring half of the time of an FSI simulation) and easier to implement, which are important requirements for clinical translation.

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Section: Aortic Dissection Case Studymentioning

confidence: 79%

“…Pressure differences between TL and FL might provide important diagnostic and prognostic information [28], but cannot be easily assessed in the clinic. For instance, higher pressure in the FL can lead to further expansion, or even rupture of the FL, whilst causing a narrowing of the TL [5,7].…”

Section: Aortic Dissection Case Studymentioning

confidence: 99%

A simplified method to account for wall motion in patient-specific blood flow simulations of aortic dissection: Comparison with fluid-structure interaction

Bonfanti

Balabani

Alimohammadi

et al. 2018

Medical Engineering & Physics

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“…As shown by Rudenick et al [10] via a lumped parameter model and confirmed by Bonfanti et al [11] with a CFD model, the wall compliance can indeed have a significant effect on the pressure in the FL, in particular when the size of the connecting tears is small. However, the majority of published AD models [12][13][14][15][16][17] assumes rigid-walls and neglects compliance effects on the predicted pressures. Advanced CFD models of AD account for the motion of the vessel walls using fluidstructure interaction (FSI) or moving boundary approaches [11,[18][19][20] which, in order to be patient-specific, need to be informed by nonroutine displacement data obtained, for example, via cine-MRI.…”

Section: Introductionmentioning

confidence: 99%

Patient-specific haemodynamic simulations of complex aortic dissections informed by commonly available clinical datasets

Bonfanti

Franzetti

Maritati

et al. 2019

Medical Engineering & Physics

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Patient-specific computational fluid-dynamics (CFD) can assist the clinical decision-making process for Type-B aortic dissection (AD) by providing detailed information on the complex intra-aortic haemodynamics. This study presents a new approach for the implementation of personalised CFD models using non-invasive, and oftentimes minimal, datasets commonly collected for AD monitoring. An innovative way to account for arterial compliance in rigid-wall simulations using a lumped capacitor is introduced, and a parameter estimation strategy for boundary conditions calibration is proposed. The approach was tested on three complex cases of AD, and the results were successfully compared against invasive blood pressure measurements. Haemodynamic results (e.g. intraluminal pressures, flow partition between the lumina, wall shear-stress based indices) provided information that could not be obtained using imaging alone, providing insight into the state of the disease. It was noted that small tears in the distal intimal flap induce disturbed flow in both lumina. Moreover, oscillatory pressures across the intimal flap were often observed in proximity to the tears in the abdominal region, which could indicate a risk of dynamic obstruction of the true lumen. This study shows how combining commonly available clinical data with computational modelling can be a powerful tool to enhance clinical understanding of AD.

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“…The same pulsatile velocity and pressure boundary conditions were assigned for each patient case (CTA-reconstructed model and VSA-simulated model) at the inlet and outlets. The inlet velocity boundary at the ascending aorta and the outlet velocity at the three aortic branches for each patient were obtained by ultrasound velocimetry as described in our previous study 30 , and the outlet pressure boundaries at the abdominal branches and common iliac arteries for each patient were assigned according to 31 . The vessel walls of both the CTA-reconstructed and VSA-simulated models were assumed to be rigid.…”

Section: Methodsmentioning

confidence: 99%

Virtual stenting with simplex mesh and mechanical contact analysis for real-time planning of thoracic endovascular aortic repair

Chen¹,

Ji²,

Deng³

et al. 2018

Theranostics

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In aortic endovascular repair, the prediction of stented vessel remodeling informs treatment plans and risk evaluation; however, there are no highly accurate and efficient methods to quantitatively simulate stented vessels. This study developed a fast virtual stenting algorithm to simulate stent-induced aortic remodeling to assist in real-time thoracic endovascular aortic repair planning.Methods: The virtual stenting algorithm was established based on simplex deformable mesh and mechanical contact analysis. The key parameters of the mechanical contact analysis were derived from mechanical tests on aortic tissue (n=40) and commonly used stent-grafts (n=6). Genetic algorithm was applied to select weighting parameters. Testing and validation of the algorithm were performed using pre- and post-treatment computed tomography angiography datasets of type-B aortic dissection cases (n=66).Results: The algorithm was efficient in simulating stent-induced aortic deformation (mean computing time on a single processor: 13.78±2.80s) and accurate at the morphological (curvature difference: 1.57±0.57%; cross-sectional area difference: 4.11±0.85%) and hemodynamic (similarity of wall shear stress-derived parameters: 90.16-90.94%) levels. Stent-induced wall deformation was higher (p<0.05) in distal stent-induced new entry cases than in successfully treated cases, and this deformation did not differ significantly among the different stent groups. Additionally, the high stent-induced wall deformation regions and the new-entry sites overlapped, indicating the usefulness of wall deformation to evaluate the risks of device-induced complications.Conclusion: The novel algorithm provided fast real-time and accurate predictions of stent-graft deployment with luminal deformation tracking, thereby potentially informing individualized stenting planning and improving endovascular aortic repair outcomes. Large, multicenter studies are warranted to extend the algorithm validation and determine stress-induced wall deformation cutoff values for the risk stratification of particular complications.

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Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups

Cited by 45 publications

References 35 publications

A simplified method to account for wall motion in patient-specific blood flow simulations of aortic dissection: Comparison with fluid-structure interaction

A simplified method to account for wall motion in patient-specific blood flow simulations of aortic dissection: Comparison with fluid-structure interaction

Patient-specific haemodynamic simulations of complex aortic dissections informed by commonly available clinical datasets

Virtual stenting with simplex mesh and mechanical contact analysis for real-time planning of thoracic endovascular aortic repair

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