Geometric Analysis of Type B Aortic Dissections Shows Aortic Remodeling After Intervention Using Multilayer Stents

Abstract

Recently, multilayer stents for type B aortic dissections (TBAD) have been proposed to decrease false lumen flow, increase and streamline true lumen flow, and retain branch vessel patency. We aimed to provide a protocol with standardized techniques to investigate aortic remodeling of TBAD by multilayer flow modulators (MFM) in static geometric and hemodynamic analyses. Combining existing literature and new insights, a standardized protocol was designed. Using pre- and postoperative CT scans, geometric models were constructed, lumen dimensions were calculated, computational fluid dynamics (CFD) models were composed, and velocity and pressures were calculated. Sixteen TBAD cases treated with MFM were included for analysis. For each case, aortic remodeling was analyzed using post-processing medical imaging software. After 3D models were created, geometrical anatomical measurements were performed, and meshes for finite element analysis were generated. MFM cases were compared pre- and postoperatively; true lumen volumes increased (p < 0.001), false lumen volumes decreased (p = 0.001), true lumen diameter at the plane of maximum compression (PMC) increased (p < 0.001), and false lumen index decreased (p = 0.008). True lumen flow was streamlined, and the overall fluid velocity and pressures decreased (p < 0.001 and p = 0.006, respectively). This protocol provided a standardized method to evaluate the effects of MFM treatments in TBAD on geometric analyses, PMC, and CFD outcomes.

Same Clinical Reality of Spontaneous Rupture of the Common Iliac Artery with Pseudoaneurysm Formation—Comparison of Two Therapeutical Solutions, Endovascular Stent-Graft and Open Surgical Correction, for Two Cases and Review of the Literature

“…In the presence of local mass effects and in cases where interventional treatment has failed, open surgery is considered the method of choice. Many recommend it in patients with infected pseudoaneurysms, but the infection is not an absolute contraindication to endovascular techniques and management should be tailored to every case [ 11 , 12 , 13 , 14 , 15 ]. Surgical treatment disadvantages, such as long hospitalization time, requirement of general anesthesia, impaired wound healing, and an association with a higher morbidity and mortality rate, have shifted interest towards endovascular procedures.…”

The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

“…Several studies have focused on TEVAR based on the prediction of thrombus formation and growth of the FL 13 , 32 – 35 . Recent work has demonstrated the potential use of CFD simulations in the hemodynamic analysis of type-B AD before and after treatment with multilayer flow modulators stents 36 . Advances in the investigation of hemodynamic metrics have allowed for the diagnosing of common pathologies in type-B AD patients, which have aided clinicians in their decision-making process.…”