Where to Fenestrate in Aortic Dissection Type B? An Ex Vivo Study

Veger, Hugo T.C.; Pasveer, Erik; Visser, M.J.T.

doi:10.1016/j.avsg.2017.03.170

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…This study and our previous studies showed that this ex vivo porcine model is a representative model to study different aspects of ABAD. 14,17 In all 3 models, the aortic wall elasticity (expressed in AP diameter change) was significantly decreased after siliconizing. The diameter of the MFL and DFL expanded significantly in all models when the aortic wall elasticity decreased.…”

Section: Discussionmentioning

confidence: 95%

“…An in vitro study in the previously validated aortic dissection model has the potential to study a specific parameter in a controlled setting. 14,17 In this study, a porcine aorta—instead of synthetic polymer or silicon tubing—was used as a “modeled” aorta. 7,18 Research showed that elasticity and morphology of a young porcine aorta corresponds to the human thoracic aorta under 65 years.…”

Section: Discussionmentioning

confidence: 99%

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The Influence of Aortic Wall Elasticity on the False Lumen in Aortic Dissection: An In Vitro Study

Veger

Pasveer

Westenberg

et al. 2020

Vasc Endovascular Surg

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Background: Hemodynamics, dissection morphology, and aortic wall elasticity have a major influence on the pressure in the false lumen. In contrast to aortic wall elasticity, the influence of hemodynamics and dissection morphology have been investigated often in multiple in vitro and ex vivo studies. The purpose of this study was to evaluate the influence of aortic wall elasticity on the diameter and pressure of the false lumen in aortic dissection. Methods: An artificial dissection was created in 3 ex vivo porcine aortas. The aorta models were consecutively positioned in a validated in vitro circulatory system with physiological pulsatile flow. Each model was imaged with ultrasound on 4 positions along the aorta and the dissection. At these 4 locations, pressure measurement was also performed in the true and false lumen with an arterial catheter. After baseline experiments, the aortic wall elasticity was adjusted with silicon and the experiments were repeated. Results: The aortic wall elasticity was decreased in all 3 models after siliconizing. In all 3 siliconized models, the diameters of the true and false lumen increased at proximal, mid, and distal location, while the mean arterial pressure did not significantly change. Conclusions: In this in vitro study, we showed that aortic wall elasticity is an important parameter altering the false lumen. An aortic wall with reduced elasticity results in an increased false lumen diameter in the mid and distal part of the false lumen. These results can only be transferred to corresponding clinical situations to a limited extent.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

The Influence of Aortic Wall Elasticity on the False Lumen in Aortic Dissection: An In Vitro Study

Veger

Pasveer

Westenberg

et al. 2020

Vasc Endovascular Surg

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“…21 This implies together with our previously published studies that our ex-vivo porcine aorta model is a representative model to study uTBAD. 7,22 Earlier research on aortic dissection by 4D flow MRI was only performed using silicon models and resulted in hemodynamic insights into aortic dissection.4 Other in-vitro study on hemodynamics in aorta dissection showed that if a distal tear in the false lumen was absent the diastolic pressure in the false lumen increased compared to the true lumen diastolic pressure. 14 However, it should be noted that these last 2 mentioned studies did not use biological tissue but were based on experiments with synthetic polymer or silicon tubing.…”

Section: Discussionmentioning

confidence: 99%

Wall Shear Stress Assessment of the False Lumen in Acute Type B Aortic Dissection Visualized by 4-Dimensional Flow Magnetic Resonance Imaging: An Ex-Vivo Study

Veger

Pasveer

Westenberg

et al. 2021

Vasc Endovascular Surg

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Background: Four-dimensional flow magnetic resonance imaging (4D flow MRI) can accurately visualize and quantify flow and provide hemodynamic information such as wall shear stress (WSS). This imaging technique can be used to obtain more insight in the hemodynamic changes during cardiac cycle in the true and false lumen of uncomplicated acute Type B Aortic Dissection (TBAD). Gaining more insight of these forces in the false lumen in uncomplicated TBAD during optimal medical treatment, might result in prediction of adverse outcomes. Methods: A porcine aorta dissection model with an artificial dissection was positioned in a validated ex-vivo circulatory system with physiological pulsatile flow. 4D flow MR images with 3 set heartrates (HR; 60 bpm, 80 bpm and 100 bpm) were acquired. False lumen volume per cycle (FLV), mean and peak systolic WSS were determined from 4D flow MRI data. For validation, the experiment was repeated with a second porcine aorta dissection model. Results: During both experiments an increase in FLV (initial experiment: ΔFLV = 2.05 ml, p < 0.001, repeated experiment: ΔFLV = 1.08 ml, p = 0.005) and peak WSS (initial experiment: ΔWSS = 1.2 Pa, p = 0.004, repeated experiment: ΔWSS = 1.79 Pa, p = 0.016) was observed when HR increased from 60 to 80 bpm. Raising the HR from 80 to 100 bpm, no significant increase in FLV ( p = 0.073, p = 0.139) was seen during both experiments. The false lumen mean WSS increased significant during initial (2.71 to 3.85 Pa; p = 0.013) and non-significant during repeated experiment (3.22 to 4.00 Pa; p = 0.320). Conclusion: 4D flow MRI provides insight into hemodynamic dimensions including WSS. Our ex-vivo experiments showed that an increase in HR from 60 to 80 bpm resulted in a significant increase of FLV and WSS of the false lumen. We suggest that strict heart rate control is of major importance to reduce the mean and peak WSS in uncomplicated acute TBAD. Because of the limitations of an ex-vivo study, 4D flow MRI will have to be performed in clinical setting to determine whether this imaging model would be of value to predict the course of uncomplicated TBAD.

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“…Some authors recently suggested the potential benefit of routine fenestration in the distal aorta to prevent or improve spinal cord malperfusion in patients where stent graft within the descending thoracic aorta would be deployed with lots of intercostal arteries seen arising from the false lumen. Moreover, and contrary to what has been generally assumed, the authors suggest this would result in largest false lumen reduction and thus lower risk of aneurysmal degeneration of the distal aorta [10]. The understanding of the mechanisms of spinal cord malperfusion in this setting remain somehow unclear and it may feel premature to rely on single preoperative CTA analysis at this stage to decide on extensive coverage followed by fenestration to limit any spinal cord ischemia.…”

mentioning

confidence: 91%