The role of multiple re-entry tears in type B aortic dissection progression: a longitudinal study using a controlled swine model
File(s)
Author(s)
Type
Journal Article
Abstract
Purpose: False lumen (FL) expansion often occurs in type B aortic dissection (TBAD) and has
been associated with the presence of re-entry tears. This longitudinal study aims to elucidate
the role of re-entry tears in the progression of TBAD using a controlled swine model, by
assessing aortic hemodynamics through combined imaging and computational modelling.
Materials and Methods: A TBAD swine model with a primary entry tear at 7 cm distal to the
left subclavian artery was created in a previous study. In the current study, re-intervention
was carried out in this swine model to induce two additional re-entry tears of approximately
5 mm in diameter. CT and 4D-flow MRI scans were taken at multiple follow-ups before and
after re-intervention. Changes in aortic volume were measured on CT scans, and
hemodynamic parameters were evaluated based on dynamic data acquired with 4D-flow MRI
and computational fluid dynamics simulations incorporating all available in-vivo data.
Results: Morphological analysis showed FL growth of 20% following the initial TBAD – growth
stabilised after the creation of additional tears and eventually FL volume reduced by 6%.
Increasing the number of re-entry tears from one to two caused flow redistribution, with the
percentage of true lumen (TL) flow increasing from 56% to 78%, altered local velocities,
reduced wall shear stress surrounding the tears, and led to a reduction in FL pressure and
pressure difference between the two lumina.
Conclusion: This study combined extensive in-vivo imaging data with sophisticated
computational methods to show that additional re-entry tears can alter dissection
hemodynamics through redistribution of flow between the TL and FL. This helps to reduce FL
pressure, which could potentially stabilise aortic growth and lead to reversal of FL expansion.
This work provides a starting point for further study into the use of fenestration in controlling
undesirable FL expansion.
been associated with the presence of re-entry tears. This longitudinal study aims to elucidate
the role of re-entry tears in the progression of TBAD using a controlled swine model, by
assessing aortic hemodynamics through combined imaging and computational modelling.
Materials and Methods: A TBAD swine model with a primary entry tear at 7 cm distal to the
left subclavian artery was created in a previous study. In the current study, re-intervention
was carried out in this swine model to induce two additional re-entry tears of approximately
5 mm in diameter. CT and 4D-flow MRI scans were taken at multiple follow-ups before and
after re-intervention. Changes in aortic volume were measured on CT scans, and
hemodynamic parameters were evaluated based on dynamic data acquired with 4D-flow MRI
and computational fluid dynamics simulations incorporating all available in-vivo data.
Results: Morphological analysis showed FL growth of 20% following the initial TBAD – growth
stabilised after the creation of additional tears and eventually FL volume reduced by 6%.
Increasing the number of re-entry tears from one to two caused flow redistribution, with the
percentage of true lumen (TL) flow increasing from 56% to 78%, altered local velocities,
reduced wall shear stress surrounding the tears, and led to a reduction in FL pressure and
pressure difference between the two lumina.
Conclusion: This study combined extensive in-vivo imaging data with sophisticated
computational methods to show that additional re-entry tears can alter dissection
hemodynamics through redistribution of flow between the TL and FL. This helps to reduce FL
pressure, which could potentially stabilise aortic growth and lead to reversal of FL expansion.
This work provides a starting point for further study into the use of fenestration in controlling
undesirable FL expansion.
Date Issued
2024-02-01
Date Acceptance
2022-06-09
Citation
Journal of Endovascular Therapy, 2024, 31 (1), pp.104-114
ISSN
1074-6218
Publisher
SAGE Publications
Start Page
104
End Page
114
Journal / Book Title
Journal of Endovascular Therapy
Volume
31
Issue
1
Copyright Statement
© The Author(s) 2022. This work is published under a CC BY licence.
License URL
Identifier
https://journals.sagepub.com/doi/10.1177/15266028221111295
Publication Status
Published
Date Publish Online
2022-07-19