Hemodynamic Analysis to Assist Treatment Strategies in Complex Visceral Arterial Pathologies: Case Reports and discussion from Pancreaticoduodenal Artery Aneurysm with Superior Mesenteric Artery Occlusion

Li, Da; Ma, Jinman; Wei, Chijun; Zhao, Jichun; Yuan, Ding; Zheng, Tinghui

doi:10.1016/j.avsg.2019.02.049

Cited by 4 publications

(5 citation statements)

References 27 publications

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“…Yuhn et al investigated the hemodynamic characteristics of patients with CA stenosis and simulated arterial modeling of the PDA ( 24 ). Li et al simulated the flow field WSS of a patient with PDAA accompanied by SMA occlusion to predict the outcome of different operation strategies ( 25 ). Additionally, Yonn et al used an electric circuit model to explore the relationship between CA stenosis and PDA perfusion ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Patient-specific modeling of hemodynamic characteristics associated with the formation of visceral artery aneurysms at uncommon locations

Sun

Chen

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveHemodynamic characteristics play critical roles in aneurysm initiation and growth. This study aims to explore the effect of common hemodynamic parameters on the formation of visceral artery aneurysms (VAAs), especially those from the pancreaticoduodenal arteries or other uncommon locations, using real patients’ models.MethodsThree-dimension vessel models of 14 VAAs from 13 patients were selected and constructed from computed tomography angiography (CTA) images. Aneurysms were manually removed to perform computational fluid dynamics (CFD) simulations of the models before aneurysm formation. Flow field characteristics were obtained and compared at the aneurysm forming and para-aneurysm areas. Aneurysm forming models were categorized into high-wall-shear stress (WSS) and low-WSS groups according to WSS value at aneurysm forming versus para-aneurysm areas.ResultsComputational fluid dynamics analysis revealed that the high WSS group had significantly higher WSSmax (P = 0.038), higher time average WSS (TAWSS) (P = 0.011), higher WSS gradient (WSSG) (p = 0.036), as well as lower oscillatory shear index (OSI) (P = 0.022) compared to the low WSS group. Significant higher WSSmax (P = 0.003), TAWSS (P = 0.003), WSSG (P = 0.041) and lower OSI (P = 0.021) was observed at the aneurysm forming site compared to both upstream and downstream areas.ConclusionBoth local increase and decrease of WSS and WSS gradient were observed for the visceral artery aneurysm forming area. Computational fluid dynamics analysis could shed light on the pathogenesis of visceral artery aneurysms at uncommon vessel locations.

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Section: Discussionmentioning

confidence: 99%

Patient-specific modeling of hemodynamic characteristics associated with the formation of visceral artery aneurysms at uncommon locations

Sun

Chen

et al. 2022

Front. Cardiovasc. Med.

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“… 3 Owing to significant morbidity and mortality associated with IPDA pseudoaneurysm, prompt diagnosis and management is imperative. 4 …”

Section: Case Reportmentioning

confidence: 99%

Bleeding Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery as an Endoscopic Retrograde Cholangiopancreatography Complication

Rim

Cieslak

et al. 2021

ACG Case Rep J

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A 27-year-old man with a history of sickle cell disease presented with 2 months of epigastric abdominal pain associated with nausea and decreased appetite. Abdominal and pelvic computed tomography (CT) angiogram on presentation showed mild thickening of the gallbladder wall, hyperemia, and small cholecystic fluid. Right upper quadrant abdominal ultrasound showed cholelithiasis, biliary sludge, and gallbladder wall thickening without Murphy sign. Biliary ductal dilation was seen without sonographic evidence of stones. Magnetic resonance cholangiopancreatography showed sludge and a single 0.4 cm stone in the distal common bile duct, sludge/stones in the gallbladder, and mild gallbladder wall thickening. Endoscopic retrograde cholangiopancreatography was performed the next day, which showed black pigmented stones. Sphincterotomy was performed, followed by stone extraction and biliary stent placement; the pancreatic duct was cannulated; therefore, a stent was placed in the main pancreatic duct. Figure 1. A focus of contrast blush posterior to the second portion of the duodenum (black arrow) was shown in the abdominal computed tomography with contrast.

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“…Finally, a study using pancreaticoduodenal artery aneurysm (PDAA) CFD models with superior mesenteric artery (SMA) occlusion resulted in analysis of the best treatment strategy. Surgery without revascularization could lead to recurrence of the PDAA, while revascularization could lead to high WSS and pressure (Li et al, 2019). These findings lead to stagnant flow in the pancreaticoduodenal artery (PDA), suggesting that revascularization can occlude the PDA and increase blood flow through the SMA (Li et al, 2019).…”

Section: Peripheral and Visceral Aneurysmsmentioning

confidence: 99%

“…Surgery without revascularization could lead to recurrence of the PDAA, while revascularization could lead to high WSS and pressure (Li et al, 2019). These findings lead to stagnant flow in the pancreaticoduodenal artery (PDA), suggesting that revascularization can occlude the PDA and increase blood flow through the SMA (Li et al, 2019). Overall, the low prevalence, variation in anatomical location, and complex hemodynamics in peripheral and visceral vessels provide unique challenges when simulating blood flow.…”

Section: Peripheral and Visceral Aneurysmsmentioning

confidence: 99%

Computational Hemodynamic Modeling of Arterial Aneurysms: A Mini-Review

et al. 2020

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Arterial aneurysms are pathological dilations of blood vessels, which can be of clinical concern due to thrombosis, dissection, or rupture. Aneurysms can form throughout the arterial system, including intracranial, thoracic, abdominal, visceral, peripheral, or coronary arteries. Currently, aneurysm diameter and expansion rates are the most commonly used metrics to assess rupture risk. Surgical or endovascular interventions are clinical treatment options, but are invasive and associated with risk for the patient. For aneurysms in locations where thrombosis is the primary concern, diameter is also used to determine the level of therapeutic anticoagulation, a treatment that increases the possibility of internal bleeding. Since simple diameter is often insufficient to reliably determine rupture and thrombosis risk, computational hemodynamic simulations are being developed to help assess when an intervention is warranted. Created from subjectspecific data, computational models have the potential to be used to predict growth, dissection, rupture, and thrombus-formation risk based on hemodynamic parameters, including wall shear stress, oscillatory shear index, residence time, and anomalous blood flow patterns. Generally, endothelial damage and flow stagnation within aneurysms can lead to coagulation, inflammation, and the release of proteases, which alter extracellular matrix composition, increasing risk of rupture. In this review, we highlight recent work that investigates aneurysm geometry, model parameter assumptions, and other specific considerations that influence computational aneurysm simulations. By highlighting modeling validation and verification approaches, we hope to inspire future computational efforts aimed at improving our understanding of aneurysm pathology and treatment risk stratification.

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Hemodynamic Analysis to Assist Treatment Strategies in Complex Visceral Arterial Pathologies: Case Reports and discussion from Pancreaticoduodenal Artery Aneurysm with Superior Mesenteric Artery Occlusion

Cited by 4 publications

References 27 publications

Patient-specific modeling of hemodynamic characteristics associated with the formation of visceral artery aneurysms at uncommon locations

Patient-specific modeling of hemodynamic characteristics associated with the formation of visceral artery aneurysms at uncommon locations

Bleeding Pseudoaneurysm of the Inferior Pancreaticoduodenal Artery as an Endoscopic Retrograde Cholangiopancreatography Complication

Computational Hemodynamic Modeling of Arterial Aneurysms: A Mini-Review

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