Impact of Aortic Tortuosity on Displacement Forces in Descending Thoracic Aortic Aneurysms.

Autor: Belvroy VM; Thoracic Aortic Research Centre, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Houston Methodist DeBakey Heart & Vascular Centre, Houston, TX, USA; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands. Electronic address: vionybelvroy@hotmail.com., Romarowski RM; 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy., van Bakel TMJ; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands., van Herwaarden JA; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands., Bismuth J; Houston Methodist DeBakey Heart & Vascular Centre, Houston, TX, USA., Auricchio F; Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy., Moll FL; Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands., Trimarchi S; Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico Milano, Milan, Italy; Department of Health and Community Sciences, University of Milan, 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] 2020 Apr; Vol. 59 (4), pp. 557-564. Date of Electronic Publication: 2020 Jan 07.
DOI: 10.1016/j.ejvs.2019.09.503
Abstrakt: Objective: As elastin fibres in the aorta deteriorate with age, the descending thoracic aorta (DTA) becomes longer and more tortuous. In patients with DTA aneurysms, this increased tortuosity may result in a hostile haemodynamic environment for thoracic endovascular aortic repair (TEVAR). The objective of this study was to analyse how increased tortuosity affects haemodynamic displacement forces (DFs) in different segments of the DTA in patients with DTA aneurysms (DTAAs).
Methods: Thirty patients with DTAAs were selected to form three equal groups based on the maximum tortuosity of their DTA: low < 30°, moderate 30°-60°, and high > 60°. Computational fluid dynamics simulations were performed to calculate DFs in all patients. Image based segmentations were carried out to create patient specific models of the aortic geometry. When physiological simulation results were obtained, the haemodynamic DFs on the aortic wall were calculated in four segments of the DTA (zones 4A - D). To enable comparison of DFs in different segments, the DF was normalised by the aortic wall surface area, the equivalent surface traction (EST).
Results: The mean age was 73 years, with 67% male. In zone 4C, where most tortuosity occurs, the EST in patients with high tortuosity was more than three times higher, than those with low tortuosity (low, 743 N/m 2 ; moderate, 956 N/m 2 ; high, 2294 N/m 2 ; p = .004). These differences could be attributed to the higher sideways components of the DF vectors, which were more than two times greater in patients with high tortuosity than in patients with low or moderate tortuosity (low, 5.01 N; moderate, 5.50 N; high, 13.21 N; p = .009).
Conclusion: High tortuosity results in increased displacement forces in the distal segments of the DTA. These forces should be taken into account when planning for TEVAR, as potentially they increase the risk of stent graft related complications, such as migration and endoleak.
(Copyright © 2019 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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