research-article

Hemodynamics of different configurations of the left subclavian artery parallel stent graft for thoracic endovascular aortic repair

Authors:

Yue Che,

Chang ShuAuthors Info & Claims

Volume 241, Issue C

https://doi.org/10.1016/j.cmpb.2023.107741

Published: 01 November 2023 Publication History

Highlights

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Adopt multidisciplinary means of mathematics, fluid mechanics and clinical medicine.

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Provide theoretical basis for the selection of parallel stent configurations.

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Compensate for differences of physician's experience in parallel graft technique.

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Predict complication risk after parallel graft technique from multiple perspectives.

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Assist in formulating personalized and precise parallel graft technique schemes.

Abstract

Background and objective

Parallel (chimney and periscope) graft technique is an effective approach for left subclavian artery (LSA) reconstruction in patients treated by thoracic endovascular aortic repair (TEVAR) for the inadequate landing zone. However, certain stent graft (SG) configurations may promote thrombosis and reduce distal blood flow, increasing risks of cerebral infarction and reintervention.

Methods

In this paper, we first attempt to systematically evaluate the hemodynamic performances of different parallel graft techniques as potential determinants of complication risks. Based on the patient-specific 3D aortic geometry undergoing parallel graft technique, fifteen models in total for five kinds of LSA branched SG configurations (Forward, Backward, Extended, Elliptical and Periscopic) were designed virtually, and the hemodynamic discrepancies between them were analyzed by computational fluid dynamics.

Results

Results show that flow rate of patients undergoing periscope technique reduces by half compared with chimney technique, suggesting that periscope SG may cause more serious flow obstruction to LSA, leading to stroke. For chimney stent structure, the extension length 0has little influence on energy loss and other parameters. Conversely, hemodynamic differences between the retrograde curvature and the antegrade curvature are significant (time average WSS: 47.07%), so the retrograde curvature might prompt SG displacement. Furthermore, the flatter chimney SG induces more aggressive hemodynamic forces, among which the difference of the maximum WSS between the flatter SG and nearly round SG reaches 65.56%, leading to the greater risk of vascular wall damage.

Conclusions

Results obtained might provide suggestions for physicians to formulate appropriate parallel graft technique schemes in TEVAR.

References

[1]

F.J. Criado, M.F. Barnatan, Y. Rizk, N.S. Clark, C.F. Wang, Technical strategies to expand stent-graft applicability in the aortic arch and proximal descending thoracic aorta, J. Endovasc. Ther. 9 (2) (2002) II32–II38. Suppl.

Highlights

Abstract

Background and objective

Methods

Results

Conclusions

References

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