Peripheral Artery Disease and Continuous Flow Left Ventricle Assist Device: An Engaging Complement Analysis May Help to Guide Treatment

Abstract

Use of continuous flow left ventricle assist device (CF-LVAD) in advanced heart failure (HF) patients results in clinically relevant improvements in survival, functional capacity, and quality of life. Peripheral artery disease (PAD) can occur in patients with CF-LVAD due to the high rate of concomitance between risk factors for atherosclerosis and HF. Diagnosis of PAD can be difficult in the specific setting of a patient supported by this kind of device because of the marked alteration in waveform morphology and velocity created by the artificial physiology of an LVAD. We report the case of a 53-year-old man with HF secondary to ischemic cardiomyopathy supported by the HeartWare HVAD as bridge to transplant, who after the implant developed symptoms suggestive of PAD. We describe additional computational flow analysis for the study of PAD-related hemodynamic disturbances induced by a CF-LVAD. Flow simulations enhance the information of clinical image data, and may have an application in clinical investigations of the risk of hemodynamic disturbances induced by LVAD implantation.

Vascular Function in Continuous Flow LVADs: Implications for Clinical Practice

“…Evaluation of PAD in the context of CF-LVAD might be challenging. The reliability of ankle-brachial index is unproven in these patients [ 139 ]. The inadequate visualization of peripheral vasculature, along with the continuous blood flow in the context of CF-LVAD, limit the role of standard imaging modalities such as Doppler ultrasound.…”

“…The inadequate visualization of peripheral vasculature, along with the continuous blood flow in the context of CF-LVAD, limit the role of standard imaging modalities such as Doppler ultrasound. Notably, Falletta et al have suggested that flow simulation with computational flow analysis might add to the yield of the current imaging tools in CF-LVAD patients [ 139 ].…”

Computational modeling of bicuspid aortopathy: Towards personalized risk strategies

“…These computational approaches are rapidly emerging in the clinical area because in-silico allows to determine patient-specific information at a level of detail otherwise impossible with standard clinical tools. Major evidences are the use of computer simulations for designing ventricular assist devices (VAD) [13,14] and studying VADrelated complications [15][16][17], developing heart valves [18], coronary stents [19] and endografts [20,21].…”

Artificial Organs 2018: A Year in Review

“…Calogero Falletta et al of the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy, reported on the case of a 53‐year‐old man with heart failure secondary to ischemic cardiomyopathy supported by the HeartWare HVAD as bridge to transplant, who after the implant developed symptoms suggestive of peripheral artery disease (PAD). They describe a computational flow analysis for the study of PAD‐related hemodynamic disturbances induced by a continuous flow left ventricular assist device (LVAD).…”