The pathogenesis of superior mesenteric artery dissection: An in-depth study based on fluid–structure interaction and histology analysis

Jia, Zhongzhi; Mei, Junhao; Ding, Wei; Zhao, Xi; Wen, Gongjian; Yu, Haiyang; Qin, Lihao; Piao, Zeyu; Chen, Wenhua; Tang, Liming

doi:10.1016/j.cmpb.2022.107187

Cited by 9 publications

(5 citation statements)

References 30 publications

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“…The morphological parameters included in this study were as follows: (1) dissection entrance length (DEL), defined as the optimal diameter length of the cross-section of the false lumen entrance channel which was calculated by Mimics Research 19.0 (Materialise HQ, Louvain, Bel-gium) based on the automatically extracted centerline of the SMAD 3D model; (2) false lumen length (FLL) and diameter, defined as the long-axis diameter and the short-axis diameter of the false lumen based on the maximum cross-section of the false lumen in sagittal reconstruction of the CTA image, respectively 5,17 ; (3) aortomesenteric angle, defined as the angle between the abdominal aorta major axis and the SMA major axis based on the sagittal reconstruction of the CTA image 18 ; (4) maximum curvature of the SMA, defined as the maximum curvature of the SMA central axis, which was automatically identified and calculated by using SOLIDWORKS 2017 (Dassault Systèmes, Paris, France) 19 ; (5) distance from the SMA ostium to the dissection origin; (6) true lumen stenosis rate, defined as the cross-sectional area at the greatest stenosis site on the true lumen divided by the proximal normal artery (the greatest stenosis location and the normal lumen diameter location at the SMA was identified by two independent interventional angiologists); and (7) the number and average diameter of side branches in the involved segment of the SMAD, quantified and measured based on a SMA 3D model extracted by Mimics Research 19.0 (Materialise, Leuven, Belgium) (Figure S1).…”

Section: Methodsmentioning

confidence: 99%

“…(3) aortomesenteric angle, defined as the angle between the abdominal aorta major axis and the SMA major axis based on the sagittal reconstruction of the CTA image 18 ; (4) maximum curvature of the SMA, defined as the maximum curvature of the SMA central axis, which was automatically identified and calculated by using SOLIDWORKS 2017 (Dassault Systèmes, Paris, France) 19 ; (5) distance from the SMA ostium to the dissection origin; (6) true lumen stenosis rate, defined as the cross-sectional area at the greatest stenosis site on the true lumen divided by the proximal normal artery (the greatest stenosis location and the normal lumen diameter location at the SMA was identified by two independent interventional angiologists); and (7) the number and average diameter of side branches in the involved segment of the SMAD, quantified and measured based on a SMA 3D model extracted by Mimics Research 19.0 (Materialise, Leuven, Belgium) (Figure S1).…”

Section: Morphological Measurementsmentioning

confidence: 99%

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Factors associated with false lumen changes in patients with superior mesenteric artery dissection

Mei,

Yuan,

Yan

et al. 2024

Vasc Med

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Background: False lumen changes (FLCs) are the main reference for the prognosis judgment and treatment plan selection for type IIa superior mesenteric artery dissection (SMAD). Methods: For this retrospective study, 55 patients with symptomatic type IIa SMAD were included. Computational fluid dynamics (CFD) analysis was used to explore the hemodynamic basis of FLCs. Correlation and multiple linear regression analyses were performed to identify clinical, morphological and hemodynamic factors associated with FLCs. Results: The FLCs of patients with successful conservative treatment ( n = 29) are significantly higher than those with failed conservative treatment ( n = 26) (58.5 ± 21.1% vs 10.9 ± 17.4%, p < 0.0001). Positive correlations were seen between FLCs and the morphological parameters false lumen length (FLL)/dissection entrance length (DEL) and FLL. In terms of hemodynamic parameters, negative correlations were seen between FLCs and time-averaged wall shear stress (TAWSS), vorticity, and high areas of TAWSS and vorticity, whereas positive correlations were seen between FLCs and oscillatory shear index (OSI), relative residence time (RRT), and high areas of OSI and RRT. Multiple linear regression analysis identified symptom duration (odds ratio [OR], 0.93; 95% CI, 0.91–0.96; p < 0.0001), FLL/DEL (OR, 1.30; 95% CI, 1.01–1.67; p = 0.044), and high RRT area (OR, 2.03; 95% CI, 1.48–2.78; p < 0.0001) as predictors of FLCs. Conclusion: The clinical predictor symptom duration, morphological factor FLL/DEL, and the hemodynamic factor high RRT area can serve as predictors of FLCs in patients with symptomatic type IIa SMAD.

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Section: Methodsmentioning

confidence: 99%

Section: Morphological Measurementsmentioning

confidence: 99%

Factors associated with false lumen changes in patients with superior mesenteric artery dissection

Mei,

Yuan,

Yan

et al. 2024

Vasc Med

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“…Steady-state flow simulations corresponding to the flow conditions at the patient-specific systolic peak were performed using the CFD solver in Fluent (Ansys, Canonsburg, PA, USA) by solving a k-ω SST transition turbulence model ( 13 ). Blood was treated as an in compressible Newtonian fluid with a density of 1,045 kg/m 3 and a dynamic viscosity of 0.00365 Pa·s ( 14 ). For the initial boundary conditions at the vascular openings, we assumed a constant velocity inlet of the patient-specific peak systolic blood flow velocity (cross-section of the abdominal aorta, 5 cm above the SMA ostium) and zero pressure outlet at SMA and cross-section of the abdominal aorta above the common iliac artery for the geometry were applied ( 15 ).…”

Section: Methodsmentioning

confidence: 99%

Different hemodynamic factors cause the occurrence of superior mesenteric atherosclerotic stenosis and superior mesenteric artery dissection

Mei

Ding

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveTo compare the hemodynamic factors involved in the occurrence of superior mesenteric atherosclerotic stenosis (SMAS) and superior mesenteric artery (SMA) dissection (SMAD).MethodsHospital records were searched to identify consecutive patients who were diagnosed with SMAS or SMAD between January 2015 and December 2021. A computational fluid dynamics (CFD) simulation method was used to assess the hemodynamic factors of the SMA in these patients. Histologic analysis was also performed on SMA specimens obtained from 10 cadavers, and scanning electron microscopy was used to evaluate collagen microstructure.ResultsA total of 124 patients with SMAS and 61 patients with SMAD were included. Most SMASs were circumferentially distributed at the SMA root, whereas the origin of most SMADs was located on the anterior wall of the curved segment of the SMA. Vortex, higher turbulent kinetic energy (TKE), and lower wall shear stress (WSS) were observed near plaques; higher TKE and WSS were seen near dissection origins. The intima in the SMA root (388.5 ± 202.3 µm) was thicker than in the curved (243.8 ± 100.5 µm; p = .007) and distal (183.7 ± 88.0 µm; p < .001) segments. The media in the anterior wall (353.1 ± 37.6 µm) was thinner than that in the posterior wall (473.7 ± 142.8 µm; p = .02) in the curved segment of the SMA. The gaps in the lamellar structure in the SMA root were larger than in the curved and distal segments. The collagen microstructure was more substantially disturbed in the anterior wall than in the posterior wall in the curved segment of the SMA.ConclusionDifferent hemodynamic factors in different portions of the SMA are related to local pathological changes in the SMA wall and may lead to the occurrence of SMAS or SMAD.

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“…The mean aortomesenteric angle (59.7 ± 21.4° vs 48.2 ± 16.8°; p < .001) and SMA maximum curvature (0.084 ± 0.078 mm-1 vs 0.032 ± 0.023 mm-1; p < .001) were higher in ISMAD patients than controls. 19 The convexity of SMA after bending causes shear stress against the anterior wall, the most common site of ISMAD. 1 …”

Section: Etiologymentioning

confidence: 99%

“… 1 , 21 , 22 Hemodynamic studies demonstrated that the distribution of wall shear stress in the SMA can cause degenerative changes in the anterior wall of the SMA, including thinning of the media, a reduced smooth muscle cell count and elastin level, translamellar mucoid extracellular matrix accumulation, elastic fiber fragmentation, and smooth muscle cell nuclei loss or disorganization. 18 , 19 , 23 …”

Section: Pathophysiologymentioning

confidence: 99%

Isolated superior mesenteric artery dissection: An updated review of the literature

Mei

Jia

2023

Journal of Interventional Medicine

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The pathogenesis of superior mesenteric artery dissection: An in-depth study based on fluid–structure interaction and histology analysis

Cited by 9 publications

References 30 publications

Factors associated with false lumen changes in patients with superior mesenteric artery dissection

Factors associated with false lumen changes in patients with superior mesenteric artery dissection

Different hemodynamic factors cause the occurrence of superior mesenteric atherosclerotic stenosis and superior mesenteric artery dissection

Isolated superior mesenteric artery dissection: An updated review of the literature

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