The Modified Arch Landing Areas Nomenclature (MALAN) Improves Prediction of Stent Graft Displacement Forces: Proof of Concept by Computational Fluid Dynamics Modelling.

Autor: Marrocco-Trischitta MM; Division of Vascular Surgery II, IRCCS - Policlinico San Donato, San Donato Milanese, Italy; Thoracic Aortic Research Centre, IRCCS - Policlinico San Donato, San Donato Milanese, Italy. Electronic address: massimiliano.marroccotrischitta@grupposandonato.it., van Bakel TM; Thoracic Aortic Research Centre, IRCCS - Policlinico San Donato, San Donato Milanese, Italy., Romarowski RM; 3D and Computer Simulation Laboratory(3), IRCCS - Policlinico San Donato, San Donato Milanese, Italy., de Beaufort HW; Thoracic Aortic Research Centre, IRCCS - Policlinico San Donato, San Donato Milanese, Italy., Conti M; Department of Civil Engineering and Architecture, Beta-lab, University of Pavia, Italy., van Herwaarden JA; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands., Moll FL; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands., Auricchio F; Department of Civil Engineering and Architecture, Beta-lab, University of Pavia, Italy., Trimarchi S; Division of Vascular Surgery II, IRCCS - Policlinico San Donato, San Donato Milanese, Italy; Thoracic Aortic Research Centre, IRCCS - Policlinico San Donato, San Donato Milanese, Italy; Chair of Vascular Surgery, University of Milan, Italy.
Jazyk: angličtina
Zdroj: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2018 Apr; Vol. 55 (4), pp. 584-592. Date of Electronic Publication: 2018 Feb 06.
DOI: 10.1016/j.ejvs.2017.12.019
Abstrakt: Objective: To assess whether the Modified Arch Landing Areas Nomenclature (MALAN), which merges Ishimaru's map with the Aortic Arch Classification, predicts the magnitude of displacement forces and their orientation in proximal landing zones for TEVAR.
Methods: Computational fluid dynamic (CFD) modelling was employed to prove the hypothesis. Healthy aorta CT angiography scans were selected based on aortic arch geometry to reflect Types I to III arches equally (each n = 5). CFDs were used to compute pulsatile displacement forces along the Ishimaru's landing zones in each aorta including their three dimensional orientation along the upward component and sideways component. Values were normalised to the corresponding aortic wall area to calculate equivalent surface traction (EST).
Results: In Types I and II arches, EST did not change across proximal landing zones (p = .297 and p = .054, respectively), whereas in Type III, EST increased towards more distal landing zones (p = .019). Comparison of EST between adjacent zones, however, showed that EST was greater in 3/II than in 2/II (p = .016), and in 3/III than in 2/III (p = .016). Notably, these differences were related to the upward component, that was four times greater in 3/II compared with 2/II (p < .001), and five times greater in 3/III compared with 2/III (p < .001).
Conclusion: CFD modelling suggests that MALAN improves discrimination of expected displacement forces in proximal landing zones for TEVAR, which might influence clinical outcomes. The clinical relevance of the finding, however, remains to be validated in a dedicated post-operative outcome analysis of patients treated by TEVAR of the arch.
(Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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