Journal of Surgery Concepts & Practice >

2023 , Vol. 28 >Issue 01: 58 - 66

DOI: https://doi.org/10.16139/j.1007-9610.2023.01.10

Original article

Outer branched and inner branched endografts in treatment of Stanford type B aortic dissection: short-term results and computational fluid dynamics analysis

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  • 1. Department of Vascular Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
    2. Department of Mechanics, Tianjin University, Tianjin 300350, China

Received date: 2022-06-13

  Online published: 2023-03-25

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Abstract

Objective To evaluate the short-term outcomes of thoracic endovascular aortic repair (TEVAR) with outer branched and inner branched endografts in the treatment of Stanford type B aortic dissection (TBAD), and to analyze the effects of endografts on blood flow status of aortic dissection by computational fluid dynamics (CFD). Methods The clinical data of TBAD patients treated with outer branched endograft technology in outer branched endograft group and inner branched endograft technology in inner branched endograft group in Department of Vascular Surgery Tianjin Medical University General Hospital from May 2018 to December 2021 were collected, and the short-term results of two groups were analyzed retrospectively. Based on CT angiography images of patients in two groups, one typical case in each group was selected to construct personalized 3D model and CFD numerical simulation was performed. The parameters including flow field velocity distribution, wall pressure and wall shear stress (WSS) before and after surgery were compared and analyzed. Results A total of 55 cases with TBAD were enrolled, consisting of 49 cased in outer branched endograft group and 6 cases in inner branched endograft group. There was no statistical difference in baseline data between two groups, and surgical success rate were both 100%. Reconstruction of left subclavical artery(LSA) simple was 41(83.7%) cases in outer branched endograft group and all 6 cases in inner branched endograft group. In outer branched endograft group there were 5 cases with reconstruction of left common carotid artery (LCCA) combined with bridging carotic clavical artery, 2 cases with reconstruction of LCCA combined with LSA embolism, and 1 case with reconstruction of LCCA combined with LSA window. Four cases were lost during follow-up in outer branched endograft group. There were no significant differences in the aorta-related mortality rate (P=1.000), branch patency rate (P=1.000) and avoidance of secondary intervention of target vessels between the two groups during the perioperative period and follow-up period (P=0.298). After endograft implantation of two groups the flow field disturbance in dissection lesions improved significantly, aortic blood flow pattern restored normal, and local abnormally increased WSS decreased. However, the interference of inner branch on aortic arch and blood flow of branch was more obvious than that of outer branch. Conclusions Both outer branched endograft and inner branched endograft TEVAR for reconstruction of LSA had good short-term results in the treatment of TBAD. Compared with inner branched endograft, outer branched endograft has a higher anatomical fit and can restore the normal blood flow to a greater extent for aortic arch.

Key words： Aortic dissection; Endovascular repair; Branched endograft; Treatment effect; Computational fluid dynamics

Cite this article

BI Jiaxue, ZHU Henghao, WANG Duan, LIU Haofei, DAI Xiangchen . Outer branched and inner branched endografts in treatment of Stanford type B aortic dissection: short-term results and computational fluid dynamics analysis[J]. Journal of Surgery Concepts & Practice, 2023 , 28(01) : 58 -66 . DOI: 10.16139/j.1007-9610.2023.01.10

References

[1] KUMAR S, CHOINSKI K N, TADROS R O. Thoracic aortic endografts: past, present, and future[J]. Surg Technol Int, 2020, 37:232-236.
[2] RIAMBAU V, B?CKLER D, BRUNKWALL J, et al. Editor′s choice-management of descending thoracic aorta diseases: clinical practice guidelines of the European Society for Vascular Surgery(ESVS)[J]. Eur J Vasc Endovasc Surg, 2017, 53(1):4-52.
[3] CANONGE J, JAYET J, HEIM F, et al. Comprehensive review of physician modified aortic stent grafts: technical and clinical outcomes[J]. Eur J Vasc Endovasc Surg, 2021, 1(4):560-569.
[4] BüNGER C M, KISCHE S, LIEBOLD A, et al. Hybrid aortic arch repair for complicated type B aortic dissection[J]. J Vasc Surg, 2013, 58(6):1490-1496.
[5] WANG T, SHU C, LI M, et al. Thoracic endovascular aortic repair with single/double chimney technique for aortic arch pathologies[J]. J Endovasc Ther, 2017, 24(3):383-393.
[6] 沈毓, 陆清声. TEVAR保留左锁骨下动脉治疗主动脉夹层[J]. 外科理论与实践, 2017, 22(4):297-299.
[6] SHEN Y, LU Q S. Thoracic endovascular aortic repair with preservation of left subclavian artery for aortic dissection[J]. J Surg Concepts Pract, 2017, 22(4):297-299.
[7] KARMONIK C, BISMUTH J, DAVIES M G, et al. A computational fluid dynamics study pre- and post-stent graft placement in an acute type B aortic dissection[J]. Vasc Endovascular Surg, 2011, 45(2):157-164.
[8] 李伟浩, 沈晨阳, 张小明, 等. 计算流体力学技术在胸主动脉疾病中的应用[J]. 中华外科杂志, 2015, 53(8):637-640.
[8] LI W H, SHEN C Y, ZHANG X M, et al. Role of computational fluid dynamics in thoracic aortic diseases research: technical superiority and application prospect[J]. Chin J Surg, 2015, 53(8):637-640.
[9] 刘东婷, 刘家祎, 温兆赢, 等. 4D Flow MRI对主动脉夹层患者腹部血流模式的定量研究及评估[J]. 放射学实践, 2017, 32(4):388-394.
[9] LIU D T, LIU J Y, WEN Z Y, et al. Quantitative study on abdominal blood flow patterns in patients with aortic dissection using 4D flow MRI[J]. Radiol Pract, 2017, 32(4):388-394.
[10] XU H, XIONG J, HAN X, et al. Computed tomography-based hemodynamic index for aortic dissection[J]. J Thorac Cardiovasc Surg, 2021, 162(2):e165-e176.
[11] MORBIDUCCI U, PONZINI R, GALLO D, et al. Inflow boundary conditions for image-based computational hemodynamics: impact of idealized versus measured veloci-ty profiles in the human aorta[J]. J Biomech, 2013, 46(1):102-109.
[12] JING Z, LU Q, FENG J, et al. Endovascular repair of aortic dissection involving the left subclavian artery by castor stent graft: a multicentre prospective trial[J]. Eur J Vasc Endovasc Surg, 2020, 60(6):854-861.
[13] 马晓丹, 李芬, 朱雅亭, 等. 模块化内嵌分支支架形态特征对支架内血流动力学的影响[J]. 医用生物力学, 2022, 37(1):124-130.
[13] MA X D, LI F, ZHU X T, et al. Influences of morpholo-gicai characteristics of modular inner branched stent graft on hemodynamic performance of stent[J]. J Med Biomech, 2022, 37(1):124-130.
[14] CHEN D, MüLLER-ESCHNER M, KOTELIS D, et al. A longitudinal study of type-B aortic dissection and endovascular repair scenarios: computational analyses[J]. Med Eng Phys, 2013, 35(9):1321-1330.
[15] XU H, LI Z, DONG H, et al. Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: a preliminary study on long-term multiple follow-ups[J]. Med Eng Phys, 2017, 50:12-21.
[16] OSSWALD A, KARMONIK C, ANDERSON J R, et al. Elevated wall shear stress in aortic type B dissection may relate to retrograde aortic type A dissection: a computational fluid dynamics pilot study[J]. Eur J Vasc Endovasc Surg, 2017, 54(3):324-330.
[17] MUNSHI B, PARKER L P, NORMAN P E, et al. The application of computational modeling for risk prediction in type B aortic dissection[J]. J Vasc Surg, 2020, 71(5):1789-1801.
[18] 乔永辉, 罗坤, 樊建人, 等. 伴随原位开窗的胸主动脉腔内修复术后血液两相流动数值模拟[J]. 中国科学院大学学报, 2020, 37(2):192-197.
[18] QIAO Y H, LUO K, FAN J R, et al. Numerical simulation of two-phase blood flow after thoracic endovascular aortic repair with in situ fenestration[J]. J Univ Chin Acad Sci, 2020, 37(2):192-197.
[19] 毛乐, 乔永辉, 栾靖旸, 等. 开窗技术数值模拟在主动脉弓部病变中的应用[J]. 中国临床医学, 2021, 28(3):375-380.
[19] MAO L, QIAO Y H, LUAN J Y, et al. Insights on hemodynamic variation after fenestrated thoracic endovascular aortic repair for aortic arch lesion[J]. Chin J Clin Med, 2021, 28(3):375-380.
[20] GEORGAKARAKOS E, IOANNOU C, KOSTAS T, et al. Inflammatory response to aortic aneurysm intraluminal thrombus may cause increased 18F-FDG uptake at sites not associated with high wall stress: comment on “high levels of 18F-FDG uptake in aortic aneurysm wall are associated with high wall stress”[J]. Eur J Vasc Endovasc Surg, 2010, 39(6):795.
[21] 陈宇, 魏新, 张颖慈, 等. 基于计算流体力学的Stanford B型主动脉夹层血流动力学分析[J]. 医用生物力学, 2018, 33(6):490-495.
[21] CHEN Y, WEI X, ZHANG Y C, et al. Hemodynamic analysis of stanford type B aortic dissection based on computational fluid dynamics[J] J Med Biomech, 2018, 33(6):490-495.
[22] CHEN D, MüLLER-ESCHNER M, VON TENGG-KOBLIGK H, et al. A patient-specific study of type-B aortic dissection: evaluation of true-false lumen blood exchange[J]. Biomed Eng Online, 2013, 12:65.
[23] SHANG E K, NATHAN D P, FAIRMAN R M, et al. Use of computational fluid dynamics studies in predicting aneurysmal degeneration of acute type B aortic dissections[J]. J Vasc Surg, 2015, 62(2):279-284.
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