The location of re-entry tears affects false lumen thrombosis in aortic dissection following TEVAR
File(s)JEVT accepted version Feb2020.pdf (905.4 KB)
Accepted version
Author(s)
Armour, Chloe
Menichini, Claudia
Milinis, Kristijonas
Gibbs, Richard
Xu, Xiao
Type
Journal Article
Abstract
Purpose. Thoracic endovascular aortic repair (TEVAR) has been shown to be an effective treatment method for acute type B aortic dissection. However, it remains unclear which factors determine false lumen thrombosis (FLT) after TEVAR. In this study we assess the influence of the distance between the distal end of the stent graft and first re-entry tear (SG-FET)on the progression of FLT.Methods.Three post-operative patient-specific models were reconstructed from computed tomography scans. Two additional models were created byartificially changing the SG-FET distance in patient 1 and 2. In all five models, computational fluid dynamics simulations coupled with thrombus formation modelling were performed at physiological flow conditions.Predicted FLT was compared with follow-up scans.Results.Ourresults showed reduced false lumen flow and low time-averaged wall shear stress (TAWSS) inpatients withlarge SG-FET distances. Predicted thrombus formation and growth were consistent with follow-up scansfor all patients. Reducingthe SG-FET distanceby 30 mm in patient 1 increased flowandTAWSS in the upper abdominal false lumen, reducing the thrombus volume by 9.6%. Increasingthe SG-FET distance inpatient 2 resulted in fasterthoracic thrombosis and increased total thrombus volume.Conclusion.The location of re-entry tears can influencethe progression of FLT following TEVAR. The more distal the re-entry tear in the aorta the more likely FLTis. Hence, the distal landing zone of the stent graft should be chosen carefully to ensure a sufficient SG-FET distance.
Date Issued
2020-06-01
Date Acceptance
2020-02-05
Citation
Journal of Endovascular Therapy, 2020, 27 (3), pp.396-404
ISSN
1074-6218
Publisher
SAGE Publications
Start Page
396
End Page
404
Journal / Book Title
Journal of Endovascular Therapy
Volume
27
Issue
3
Copyright Statement
© The Author(s) 2020. The final, definitive version of this paper has been published in Journal of Endovascular Therapy by Sage Publications Ltd. All rights reserved. It is available at: https://journals.sagepub.com/doi/10.1177/1526602820917962
Sponsor
Imperial College Healthcare Charity
Grant Number
N/A
Subjects
Science & Technology
Life Sciences & Biomedicine
Surgery
Peripheral Vascular Disease
Cardiovascular System & Cardiology
aortic dissection
computational fluid dynamics
endovascular procedures
false lumen
patient-specific geometrical models
reentry tear
stent-graft
thrombosis
thoracic endovascular aortic repair
ENDOVASCULAR REPAIR
MEDICAL-TREATMENT
MANAGEMENT
HEMODYNAMICS
PREDICTORS
IMPACT
RISK
aortic dissection
computational fluid dynamics
endovascular procedures
false lumen
patient-specific geometrical models
reentry tear
stent-graft
thoracic endovascular aortic repair
thrombosis
Cardiovascular System & Hematology
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2020-05-04