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Mei J, Yuan Y, Yan H, Zhao X, Xue T, Su H, Jia Z. Factors associated with false lumen changes in patients with superior mesenteric artery dissection. Vasc Med 2024; 29:274-285. [PMID: 38334057 DOI: 10.1177/1358863x231220624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND False lumen changes (FLCs) are the main reference for the prognosis judgment and treatment plan selection for type IIa superior mesenteric artery dissection (SMAD). METHODS For this retrospective study, 55 patients with symptomatic type IIa SMAD were included. Computational fluid dynamics (CFD) analysis was used to explore the hemodynamic basis of FLCs. Correlation and multiple linear regression analyses were performed to identify clinical, morphological and hemodynamic factors associated with FLCs. RESULTS The FLCs of patients with successful conservative treatment (n = 29) are significantly higher than those with failed conservative treatment (n = 26) (58.5 ± 21.1% vs 10.9 ± 17.4%, p < 0.0001). Positive correlations were seen between FLCs and the morphological parameters false lumen length (FLL)/dissection entrance length (DEL) and FLL. In terms of hemodynamic parameters, negative correlations were seen between FLCs and time-averaged wall shear stress (TAWSS), vorticity, and high areas of TAWSS and vorticity, whereas positive correlations were seen between FLCs and oscillatory shear index (OSI), relative residence time (RRT), and high areas of OSI and RRT. Multiple linear regression analysis identified symptom duration (odds ratio [OR], 0.93; 95% CI, 0.91-0.96; p < 0.0001), FLL/DEL (OR, 1.30; 95% CI, 1.01-1.67; p = 0.044), and high RRT area (OR, 2.03; 95% CI, 1.48-2.78; p < 0.0001) as predictors of FLCs. CONCLUSION The clinical predictor symptom duration, morphological factor FLL/DEL, and the hemodynamic factor high RRT area can serve as predictors of FLCs in patients with symptomatic type IIa SMAD.
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Affiliation(s)
- Junhao Mei
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yuan Yuan
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hui Yan
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huaian's City, Huai'an, China
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
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Wang C, Chen M, Fan X, Zheng Y. Computational fluid dynamic before aortic dissection. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03139-2. [PMID: 38801546 DOI: 10.1007/s10554-024-03139-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Chaojie Wang
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Man Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoping Fan
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yuan Zheng
- Department of Cardiovascular Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Mei J, Yan H, Zhao X, Yuan Y, Su H, Xue T, Jia Z. In-stent Restenosis After Stenting for Superior Mesenteric Artery Dissection Is Associated With Stent Landing Zone: From Clinical Prediction to Hemodynamic Mechanisms. J Endovasc Ther 2024:15266028241241494. [PMID: 38561992 DOI: 10.1177/15266028241241494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To identify risk factors for in-stent restenosis (ISR) in patients undergoing stent placement for superior mesenteric artery dissection (SMAD) and to determine the hemodynamic mechanism underlying ISR. METHODS For this retrospective study, patients with SMAD who had ISR after stent placement were included in the ISR group, and age- and sex-matched patients with SMAD who did not experience ISR after stent placement were included in the control group. Clinical, imaging, and hemodynamic data were assessed. Multivariable regression was used to identify independent ISR risk factors. Structural and fluid dynamics simulations were applied to determine the hemodynamic mechanism underlying the occurrence of ISR. RESULTS The study population included 26 patients with ISR and 26 control patients. Multivariate analysis demonstrated that stent-to-vascular (S/V) ratio (odds ratio [OR], 1.14; 95% confidence interval [CI]: 1.00-1.29; p=0.045), stent proximal position >10 mm away from the SMA root (OR, 108.67; 95% CI: 3.09-3816.42; p=0.010), and high oscillatory shear index (OSI) area (OR, 1.25; 95% CI: 1.02-1.52; p=0.029) were predictors of ISR. In structural and fluid dynamics simulations, a stent proximal position near the abdominal aorta (AA) or entering into the AA reduced the contact area between the proximal struts of the stent and the vascular wall, and alleviated the distal lumen overdilation. CONCLUSION The S/V ratio, stent proximal position away from the SMA root (>10 mm), and high OSI area are independent risk factors for ISR in patients with SMAD undergoing stent placement. Deploying the proximal end of the stent near the AA or entering into the AA appears to improve the hemodynamic environment in the SMA lumen and ultimately reduce the risk of ISR. CLINICAL IMPACT In-stent restenosis is an uncommon but potentially catastrophic complication after stent placement for the management of superior mesenteric artery dissection. This study identified risk factors for in-stent restenosis and demonstrated that, as long as the stent can fully cover the dissection range, deploying the proximal end of the stent near the abdominal aorta or less entering into the abdominal aorta may reduce the risk of in-stent restenosis in this patient population.
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Affiliation(s)
- Junhao Mei
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Hui Yan
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Yuan Yuan
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City, Huai'an, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
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Lo SCY, McCullough JWS, Xue X, Coveney PV. Uncertainty quantification of the impact of peripheral arterial disease on abdominal aortic aneurysms in blood flow simulations. J R Soc Interface 2024; 21:20230656. [PMID: 38593843 PMCID: PMC11003782 DOI: 10.1098/rsif.2023.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Peripheral arterial disease (PAD) and abdominal aortic aneurysms (AAAs) often coexist and pose significant risks of mortality, yet their mutual interactions remain largely unexplored. Here, we introduce a fluid mechanics model designed to simulate the haemodynamic impact of PAD on AAA-associated risk factors. Our focus lies on quantifying the uncertainty inherent in controlling the flow rates within PAD-affected vessels and predicting AAA risk factors derived from wall shear stress. We perform a sensitivity analysis on nine critical model parameters through simulations of three-dimensional blood flow within a comprehensive arterial geometry. Our results show effective control of the flow rates using two-element Windkessel models, although specific outlets need attention. Quantities of interest like endothelial cell activation potential (ECAP) and relative residence time are instructive for identifying high-risk regions, with ECAP showing greater reliability and adaptability. Our analysis reveals that the uncertainty in the quantities of interest is 187% of that of the input parameters. Notably, parameters governing the amplitude and frequency of the inlet velocity exert the strongest influence on the risk factors' variability and warrant precise determination. This study forms the foundation for patient-specific simulations involving PAD and AAAs which should ultimately improve patient outcomes and reduce associated mortality rates.
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Affiliation(s)
- Sharp C. Y. Lo
- Centre for Computational Science, University College London, London, UK
| | | | - Xiao Xue
- Centre for Computational Science, University College London, London, UK
| | - Peter V. Coveney
- Centre for Computational Science, University College London, London, UK
- Advanced Research Computing Centre, University College London, London, UK
- Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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Zeng W, Weng C, Yuan D, Wang T, Huang B, Zhao J, Xia C, Li Z, Wang J. Multimodality magnetic resonance evaluating the effect of enhanced physical exercise on the growth rate, flow haemodynamics, aneurysm wall and ventricular-aortic coupling of patients with small abdominal aortic aneurysms (AAA MOVE trial): a study protocol for an open-label randomised controlled trial. BMJ Open 2024; 14:e080073. [PMID: 38355193 PMCID: PMC10868247 DOI: 10.1136/bmjopen-2023-080073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The best lifestyle for small abdominal aortic aneurysms (sAAA) is essential for its conservative management. Physical exercise can improve the cardiopulmonary function of the patients, but it remains unclear which specific type of exercise is most beneficial for individuals with sAAA. The current study was designed to investigate the effect of physician-guided enhanced physical exercise programme on the aorto-cardiac haemodynamic environment, aneurysm sac wall, cardiac function and growth rate of sAAA by multimodality MRI. METHODS AND ANALYSIS AAA MOVE study is a prospective, parallel, equivalence, randomised controlled trial. Eligible individuals will be recruited if they are diagnosed with sAAA (focal dilation of abdominal aorta with maximum diameter <5 cm), without contraindication for MRI scanning, or severe heart failure, or uncontrolled arrhythmia. Participants will be randomly allocated to intervention group (physician-guided enhanced physical exercise programme: mainly aerobic training) and control group (standard clinical care) separately in a 1:1 ratio. The primary outcome is 12-month growth rate of sAAA. The first set of secondary outcomes involve multimodality MRI parameters covering flow haemodynamics, aortic wall inflammation and cardiac function. The other secondary outcome (safety end point) is a composite of exercise-related injury, aneurysm rupture and aneurysm intervention. Follow-up will be conducted at 6 and 12 months after intervention. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee on Biomedical Research of West China Hospital (approval number: 2023-783) on 16 June 2023. Main findings from the trial will be disseminated through presentations at conferences, peer-reviewed publications and directly pushed to smartphone of participants. TRIAL REGISTRATION NUMBER ChiCTR2300073334.
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Affiliation(s)
- Wen Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengxin Weng
- Division of vascular surgery, Department of general surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ding Yuan
- Division of vascular surgery, Department of general surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiehao Wang
- Division of vascular surgery, Department of general surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bin Huang
- Division of vascular surgery, Department of general surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jichun Zhao
- Division of vascular surgery, Department of general surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiarong Wang
- Division of vascular surgery, Department of general surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Ma Z, Zhuang Y, Long X, Yu B, Li J, Yang Y, Yu Y. Modeling and evaluation of biomechanics and hemodynamic based on patient-specific small intracranial aneurysm using fluid-structure interaction. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 244:107963. [PMID: 38064956 DOI: 10.1016/j.cmpb.2023.107963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Rupture of small intracranial aneurysm (IA) often leads to the development of highly fatal clinical syndromes such as subarachnoid hemorrhage. Due to the patient specificity of small IA, there are many difficulties in evaluating the rupture risk of small IA such as multiple influencing factors, high clinical experience requirements and poor reusability. METHODS In this study, clinical methods such as transcranial doppler (TCD) and magnetic resonance imaging (MRI) are used to obtain patient-specific parameters, and the fluid-structure interaction method (FSI) is used to model and evaluate the biomechanics and hemodynamics of patient-specific small IA. RESULTS The results show that a spiral vortex stably exists in the patient-specific small IA. Due to the small size of the patient-specific small IA, the blood flow velocity still maintains a high value with maximum reaching 3 m/s. The inertial impact of blood flow and vortex convection have certain influence on hemodynamic and biomechanics parameters. They cause three high value areas of WSSM on the patient-specific small IA with maximum of 180 Pa, 130 Pa and 110 Pa, respectively. They also cause two types of WSS concentration points, positive normal stress peak value areas and negative normal stress peak value areas to appear. CONCLUSION This paper found that the factors affecting hemodynamic parameters and biomechanical parameters are different. Unlike hemodynamic parameters, biomechanical parameters are also affected by blood pressure in addition to blood flow velocity. This study reveals the relationship between the flow field distribution and changes of patient-specific small IA, biomechanics and hemodynamics.
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Affiliation(s)
- Zijian Ma
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China
| | - Yijie Zhuang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China.
| | - Xiaoao Long
- Neurosurgery Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong, China.
| | - Bo Yu
- Neurosurgery Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong, China
| | - Jiawang Li
- Neurosurgery Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524023, Guangdong, China
| | - Yan Yang
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China; Synergy Innovation Institute of GDUT, Shantou 515041, Guangdong, China
| | - Yingxin Yu
- Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou, 510006, China; Synergy Innovation Institute of GDUT, Shantou 515041, Guangdong, China
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Zhang Y, Shu C, Fang K, Chen D, Hou Z, Luo M. Evaluation of associations between outflow morphology and rupture risk of abdominal aortic aneurysms. Eur J Radiol 2024; 171:111286. [PMID: 38215531 DOI: 10.1016/j.ejrad.2024.111286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/24/2023] [Accepted: 01/01/2024] [Indexed: 01/14/2024]
Abstract
PURPOSE This study aimed to evaluate the association between the outflow morphology and abdominal aortic aneurysm (AAA) rupture risk, to find risk factors for future prediction models. MATERIALS AND METHODS We retrospectively analyzed 46 patients with ruptured AAAs and 46 patients with stable AAAs using a 1:1 match for sex, age, and maximum aneurysm diameter. The chi-square test, paired t-test, and Wilcoxon signed-rank test were used to compare variables. Logistic regression was performed to evaluate variables potentially associated with AAA rupture. Receiver operating characteristic curve analysis and the area under the curve (AUC) were used to assess the regression models. RESULTS Ruptured AAAs had a shorter proximal aortic neck (median (interquartile range, IQR): 24.0 (9.4-34.2) mm vs. 33.3 (20.0-52.8) mm, p = 0.004), higher tortuosity (median(IQR): 1.35 (1.23-1.49) vs. 1.29 (1.23-1.39), p = 0.036), and smaller minimum luminal area of the right common iliac artery (CIA) (median (IQR): 86.7 (69.9-126.4) mm2 vs. 118.9 (86.3-164.1)mm2, p = 0.001) and left CIA (median(IQR): 92.2 (67.3,125.1) mm2 vs. 110.7 (80.12, 161.1) mm2, p = 0.010) than stable AAA did. Multiple regression analysis demonstrated significant associations of the minimum luminal area of the bilateral CIAs (odds ratio [OR] = 0.996, 95 % confidence interval [CI] 0.991-0.999, p = 0.037), neck length (OR = 0.969, 95 % CI 0.941-0.993, p = 0.017), and aneurysm tortuosity (OR = 1.031, 95 % CI 1.003-1.063, p = 0.038) with ruptured AAAs. The AUC of this regression model was 0.762 (95 % CI 0.664-0.860, p < 0.001). CONCLUSIONS The smaller minimum luminal area of the CIA is associated with an increased risk of rupture. This study highlights the potential of utilizing outflow parameters as novel and additional tools in risk assessment. It also provides a compelling rationale to further intensify research in this area.
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Affiliation(s)
- Yidan Zhang
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China
| | - Chang Shu
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China; Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, China; Department of Vascular Surgery, Central-China Branch of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou 450046, China.
| | - Kun Fang
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China
| | - Dong Chen
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China
| | - Zhihui Hou
- Department of Radiology, Fu Wai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Mingyao Luo
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical Colege, Beijing, China; Department of Vascular Surgery, Central-China Branch of National Center for Cardiovascular Diseases, Henan Cardiovascular Disease Center, Fuwai Central-China Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou 450046, China; Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102, China.
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Gao JP, Zhang HP, Xiong J, Jia X, Ma XH, Guo W. Association Between Aneurysm Wall Inflammation Detected by Imaging Perivascular Fat and Secondary Intervention Risk for Abdominal Aortic Aneurysm Patients After Endovascular Repair. J Endovasc Ther 2023:15266028231204807. [PMID: 37853719 DOI: 10.1177/15266028231204807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate the association between the imaging biomarker (volumetric perivascular characterization index [VPCI]) which indicates the aortic wall inflammation by mapping the spatial changes of perivascular fat attenuation on computed tomography angiography (CTA) and the reintervention risk for abdominal aortic aneurysm (AAA) patients after endovascular aortic repair (EVAR). METHODS This case-control study included AAA patients undergoing EVAR from a single center (n=260). Cases were AAA patients undergoing reintervention after EVAR and a 1:1 frequency-matched control group of AAA patients post-EVAR with a shrunken or ≥3-year stable sac and free of reintervention signs during the follow-up. The predictive variable (VPCI trajectory) was converted to binary variables according to the changing trend of VPCI with follow-up time. As a quasi-complete separation data pattern, least absolute shrinkage and selection operator (lasso) regression was used to screen and prove the VPCI trajectory as the best predictor, and the performance was evaluated by calculating the accuracy, sensitivity, and specificity. RESULTS Between 2010 and 2021, 15 AAA patients after EVAR with type I/III endoleak, aneurysm rupture, or impending rupture were included. Compared with the 1:1 frequency-matched controls with a shrunken or ≥3-year stable sac and free of reintervention signs during the follow-up, VPCI trajectories of the case group were all upward trends, whereas the controls showed 86.7% downward trends (p<0.001). The best predictive model of lasso regressions included 4 variables, and VPCI trajectory was the most outstanding, followed by the proximal landing zone, the distal landing zone, and the infrarenal β angle. The accuracy, sensitivity, and specificity of predicting the risk of reintervention were as follows, respectively: 93.3%, 100%, and 86.7%. CONCLUSIONS The wall inflammation detected by imaging perivascular adipose tissue based on the CTAs was strongly associated with the reintervention risk for AAA patients after EVAR, which might hold major promise as a new imaging biomarker for the mechanism and treatment study of human AAAs before and after EVAR. CLINICAL IMPACT The study introduces a novel imaging biomarker which indicates the aortic wall inflammation by mapping spatial changes of perivascular fat attenuation on CTA. This biomarker demonstrates a strong association with the reintervention risk in AAA patients after EVAR. Incorporation of VPCI into clinical practice has the potential to enhance the traditional surveillance methods (CT/CTAs) by providing clinicians with a non-invasive method to assess aortic wall inflammation and predict the risk of reintervention. Additionally, this study might offer a valuable tool for mechanism and treatment research in humans with AAAs both pre- and post-EVAR, ultimately improving patient outcomes and refining therapeutic strategies.
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Affiliation(s)
- Jiang-Ping Gao
- Department of Vascular Surgery, Chinese PLA General Hospital, Medical School of Chinese PLA, Beijing, China
| | - Hong-Peng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Hui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China
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Brambila-Solórzano A, Méndez-Lavielle F, Naude JL, Martínez-Sánchez GJ, García-Rebolledo A, Hernández B, Escobar-del Pozo C. Influence of Blood Rheology and Turbulence Models in the Numerical Simulation of Aneurysms. Bioengineering (Basel) 2023; 10:1170. [PMID: 37892900 PMCID: PMC10604493 DOI: 10.3390/bioengineering10101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
An aneurysm is a vascular malformation that can be classified according to its location (cerebral, aortic) or shape (saccular, fusiform, and mycotic). Recently, the study of blood flow interaction with aneurysms has gained attention from physicians and engineers. Shear stresses, oscillatory shear index (OSI), gradient oscillatory number (GON), and residence time have been used as variables to describe the hemodynamics as well as the origin and evolution of aneurysms. However, the causes and hemodynamic conditions that promote their growth are still under debate. The present work presents numerical simulations of three types of aneurysms: two aortic and one cerebral. Simulation results showed that the blood rheology is not relevant for aortic aneurysms. However, for the cerebral aneurysm case, blood rheology could play a relevant role in the hemodynamics. The evaluated turbulence models showed equivalent results in both cases. Lastly, a simulation considering the fluid-structure interaction (FSI) showed that this phenomenon is the dominant factor for aneurysm simulation.
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Affiliation(s)
- Alberto Brambila-Solórzano
- Thermofluids Department, Faculty of Engineering, UNAM, Coyoacan, Mexico City C.P. 04510, Mexico (F.M.-L.); (J.L.N.); (G.J.M.-S.)
| | - Federico Méndez-Lavielle
- Thermofluids Department, Faculty of Engineering, UNAM, Coyoacan, Mexico City C.P. 04510, Mexico (F.M.-L.); (J.L.N.); (G.J.M.-S.)
| | - Jorge Luis Naude
- Thermofluids Department, Faculty of Engineering, UNAM, Coyoacan, Mexico City C.P. 04510, Mexico (F.M.-L.); (J.L.N.); (G.J.M.-S.)
| | - Gregorio Josué Martínez-Sánchez
- Thermofluids Department, Faculty of Engineering, UNAM, Coyoacan, Mexico City C.P. 04510, Mexico (F.M.-L.); (J.L.N.); (G.J.M.-S.)
| | - Azael García-Rebolledo
- Faculty of Mechanical and Electrical Engineering, Carretera Km 9 Colima-Coquimatlan, Colima C.P. 28400, Mexico
| | - Benjamín Hernández
- Oak Ridge Leadership Computing Facility, Oak Ridge National Laboratory, Oak Ridge, TN 37830, USA;
| | - Carlos Escobar-del Pozo
- Faculty of Mechanical and Electrical Engineering, Carretera Km 9 Colima-Coquimatlan, Colima C.P. 28400, Mexico
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Irfan M, Malik KM, Ahmad J, Malik G. StrokeNet: An automated approach for segmentation and rupture risk prediction of intracranial aneurysm. Comput Med Imaging Graph 2023; 108:102271. [PMID: 37556901 DOI: 10.1016/j.compmedimag.2023.102271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023]
Abstract
Intracranial Aneurysms (IA) present a complex challenge for neurosurgeons as the risks associated with surgical intervention, such as Subarachnoid Hemorrhage (SAH) mortality and morbidity, may outweigh the benefits of aneurysmal occlusion in some cases. Hence, there is a critical need for developing techniques that assist physicians in assessing the risk of aneurysm rupture to determine which aneurysms require treatment. However, a reliable IA rupture risk prediction technique is currently unavailable. To address this issue, this study proposes a novel approach for aneurysm segmentation and multidisciplinary rupture prediction using 2D Digital Subtraction Angiography (DSA) images. The proposed method involves training a fully connected convolutional neural network (CNN) to segment aneurysm regions in DSA images, followed by extracting and fusing different features using a multidisciplinary approach, including deep features, geometrical features, Fourier descriptor, and shear pressure on the aneurysm wall. The proposed method also adopts a fast correlation-based filter approach to drop highly correlated features from the set of fused features. Finally, the selected fused features are passed through a Decision Tree classifier to predict the rupture severity of the associated aneurysm into four classes: Mild, Moderate, Severe, and Critical. The proposed method is evaluated on a newly developed DSA image dataset and on public datasets to assess its generalizability. The system's performance is also evaluated on DSA images annotated by expert neurosurgeons for the rupture risk assessment of the segmented aneurysm. The proposed system outperforms existing state-of-the-art segmentation methods, achieving an 85 % accuracy against annotated DSA images for the risk assessment of aneurysmal rupture.
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Affiliation(s)
- Muhammad Irfan
- SMILES LAB, Department of Computer Science and Engineering, Oakland University, Rochester, MI, 48309, USA
| | - Khalid Mahmood Malik
- SMILES LAB, Department of Computer Science and Engineering, Oakland University, Rochester, MI, 48309, USA.
| | - Jamil Ahmad
- Department of Computer Vision, Mohamed Bin Zayed University of Artificial Intelligence (MBZUAI), Abu Dhabi, United Arab Emirates
| | - Ghaus Malik
- Executive Vice-Chair at Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
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11
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Li D, Wang L, Jiang B, Miao Y, Li X. An evidence update to explore molecular targets and protective mechanisms of apigenin against abdominal aortic aneurysms based on network pharmacology and experimental validation. Mol Divers 2023:10.1007/s11030-023-10723-6. [PMID: 37653360 DOI: 10.1007/s11030-023-10723-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Abdominal aortic aneurysms (AAA) is a life-threatening disease and the incidence of AAA is still on the rise in recent years. Numerous studies suggest that dietary moderate consumption of polyphenol exerts beneficial effects on cardiovascular disease. Apigenin (API) is a promising dietary polyphenol and possesses potent beneficial effects on our body. Although our previous study revealed protective effects of API on experimental AAA formation, up till now few studies were carried out to further investigate its involved molecular mechanisms. In the present study, network pharmacology combined molecular docking and experimental validation was used to explore API-related therapeutic targets and mechanisms in the treatment of AAA. Firstly, we collected 202 API-related therapeutic targets and 2475 AAA-related pathogenetic targets. After removing duplicates, a total of 68 potential therapeutic targets were obtained. Moreover, 5 targets with high degree including TNF, ACTB, INS, JUN, and MMP9 were identified as core targets of API for treating AAA. In addition, functional enrichment analysis indicated that API exerted pharmacological effects in AAA by affecting versatile mechanisms, including apoptosis, inflammation, blood fluid dynamics, and immune modulation. Molecular docking results further supported that API had strong affinity with the above core targets. Furthermore, protein level of core targets and related pathways were evaluated in a Cacl2-induced AAA model by using western blot and immunohistochemistry. The experimental validation results demonstrated that API significantly attenuated phosphorylation of JUN and protein level of predicted core targets. Taken together, based on network pharmacological and experimental validation, our study systematically explored associated core targets and potential therapeutic pathways of API for AAA treatment, which could supply valuable insights and theoretical basis for AAA treatment.
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Affiliation(s)
- Dongyu Li
- Department of General Surgery & VIP In-Patient Ward, The First Hospital of China Medical University, Shenyang, 110001, Liaoning Province, China
| | - Lei Wang
- Department of Vascular and Thyroid Surgery, The First Hospital of China Medical University, Nanjingbei 155 Street, Shenyang, 110001, Liaoning Province, China
| | - Bo Jiang
- Department of Vascular and Thyroid Surgery, The First Hospital of China Medical University, Nanjingbei 155 Street, Shenyang, 110001, Liaoning Province, China
| | - Yuxi Miao
- Department of Pharmacology, School of Pharmacy, China Medical University, Shenyang, 110122, Liaoning Province, China
| | - Xuan Li
- Department of Vascular and Thyroid Surgery, The First Hospital of China Medical University, Nanjingbei 155 Street, Shenyang, 110001, Liaoning Province, China.
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12
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Liu S, Long C, Hong Y, Gu X, Weng R, Zhong Z. Prevalence of risk factors associated with rupture of abdominal aortic aneurysm (AAA): a single center retrospective study. PeerJ 2023; 11:e15752. [PMID: 37554333 PMCID: PMC10405793 DOI: 10.7717/peerj.15752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/23/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Abdominal aortic aneurysm (AAA) is a severe cardiovascular disease. The mortality rate for an AAA rupture is very high. Understanding the risk factors for AAA rupture would help AAA management, but little is known about these risk factors in the Chinese population. METHODS This retrospective study included patients that were diagnosed with AAA during the last 5 years in a large national hospital in southern China. AAA patients were divided into a rupture and non-rupture group. Clinical data were extracted from the hospital medical record system. Clinical features were compared between the rupture and non-rupture groups. The associations between potential risk factors and rupture risk were evaluated using a multivariate logistic regression analysis. RESULTS A total of 337 AAA patients were included for analysis in the present study. AAA diameter was significantly larger, and high-sensitivity C-reactive protein (hs-CRP) and serum creatinine levels were both significantly higher in AAA rupture patients. High-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) levels were significantly lower in AAA rupture patients. After adjustment, the multivariate logistic analysis found that AAA diameter and hs-CRP were independently positively associated with AAA rupture, and HDL-C level was adversely associated with AAA rupture. CONCLUSIONS Our data suggests that larger AAA diameter and higher hs-CRP level are associated with a higher risk of AAA rupture, and higher HDL-C level is associated with a lower risk of AAA rupture. The results of this study may be helpful for the management of AAA patients in southern China.
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Affiliation(s)
- Sudong Liu
- Research Experimental Center, Meizhou People’s Hospital (Huangtang Hospital), Meizhou, China
- Guangdong Engineering Technology Research Center of Molecular Diagnostics for Cardiovascular Diseases, Meizhou, China
| | - Caifu Long
- Meizhou Clinical Medical School, Guangdong Medical University, Meizhou, China
| | - Yuanjia Hong
- Meizhou Clinical Medical School, Guangdong Medical University, Meizhou, China
| | - Xiaodong Gu
- Research Experimental Center, Meizhou People’s Hospital (Huangtang Hospital), Meizhou, China
- Guangdong Engineering Technology Research Center of Molecular Diagnostics for Cardiovascular Diseases, Meizhou, China
| | - Ruiqiang Weng
- Research Experimental Center, Meizhou People’s Hospital (Huangtang Hospital), Meizhou, China
- Guangdong Engineering Technology Research Center of Molecular Diagnostics for Cardiovascular Diseases, Meizhou, China
| | - Zhixiong Zhong
- Guangdong Engineering Technology Research Center of Molecular Diagnostics for Cardiovascular Diseases, Meizhou, China
- Center for Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou, China
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13
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Pajaziti E, Montalt-Tordera J, Capelli C, Sivera R, Sauvage E, Quail M, Schievano S, Muthurangu V. Shape-driven deep neural networks for fast acquisition of aortic 3D pressure and velocity flow fields. PLoS Comput Biol 2023; 19:e1011055. [PMID: 37093855 PMCID: PMC10159343 DOI: 10.1371/journal.pcbi.1011055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/04/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
Computational fluid dynamics (CFD) can be used to simulate vascular haemodynamics and analyse potential treatment options. CFD has shown to be beneficial in improving patient outcomes. However, the implementation of CFD for routine clinical use is yet to be realised. Barriers for CFD include high computational resources, specialist experience needed for designing simulation set-ups, and long processing times. The aim of this study was to explore the use of machine learning (ML) to replicate conventional aortic CFD with automatic and fast regression models. Data used to train/test the model consisted of 3,000 CFD simulations performed on synthetically generated 3D aortic shapes. These subjects were generated from a statistical shape model (SSM) built on real patient-specific aortas (N = 67). Inference performed on 200 test shapes resulted in average errors of 6.01% ±3.12 SD and 3.99% ±0.93 SD for pressure and velocity, respectively. Our ML-based models performed CFD in ∼0.075 seconds (4,000x faster than the solver). This proof-of-concept study shows that results from conventional vascular CFD can be reproduced using ML at a much faster rate, in an automatic process, and with reasonable accuracy.
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Affiliation(s)
- Endrit Pajaziti
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Javier Montalt-Tordera
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Claudio Capelli
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Raphaël Sivera
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Emilie Sauvage
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Michael Quail
- Great Ormond Street Hospital, Cardiac Unit, London, United Kingdom
| | - Silvia Schievano
- University College London, Institution of Cardiovascular Science, London, United Kingdom
| | - Vivek Muthurangu
- University College London, Institution of Cardiovascular Science, London, United Kingdom
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14
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Li D, Wang J, Zeng W, Zeng X, Liu Z, Cao H, Yuan D, Zheng T. The loss of helical flow in the thoracic aorta might be an identifying marker for the risk of acute type B aortic dissection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 230:107331. [PMID: 36621070 DOI: 10.1016/j.cmpb.2022.107331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/06/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The occurrence of acute type B aortic dissection (TBAD) remained unclear. This study aimed to investigate the association between flow features and hemodynamic parameters in aortas that demonstrated the risk of TBAD occurrence. METHODS The geometries of 15 hyperacute TBAD and 12 control patients (with healthy aorta) were reconstructed from computed tomography angiography images. Pre-TBAD models were then obtained by eliminating the dissection flaps. Flow features and hemodynamic parameters, including wall shear stress-related parameters and helicities, were compared between pre-TBAD and control models using computational fluid dynamics. RESULTS There were no significant differences in baseline characteristics and anatomical parameters between the two groups. Significant contralateral helical blood flow was present in the healthy thoracic aorta, while almost no helical flow was observed in the pre-TBAD group. In addition, the mean normal transverse wall shear stress (NtransWSS) was significantly higher in the pre-TBAD group (aortic arch 0.49±0.09 vs. 0.40±0.05, P = 0.04; descending aorta: 0.46±0.05 vs. 0.33±0.02, P<0.01). Moreover, a significantly negative correlation was found between helicity and NtransWSS in the descending aorta. Moreover, the location of primary tears in 12 pre-TABD subjects matched well with regions of high NtransWSS. CONCLUSIONS Loss of helical flow in the aortic arch and descending aorta may be a major flow feature in patients with underlying TBAD, resulting in increased flow disturbance and wall lesions.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Jiarong Wang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Wen Zeng
- Division of radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangguo Zeng
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China
| | - Zhan Liu
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Haoyao Cao
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China
| | - Ding Yuan
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; Med-X center for informatics, Sichuan University, Chengdu, China.
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, No.24 South Section 1, Chengdu 610065, China; Yibin Institute of Industrial Technology, Sichuan University Yibin Park, Yibin, China; Med-X center for informatics, Sichuan University, Chengdu, China.
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15
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Lowis C, Ramara Winaya A, Kumari P, Rivera CF, Vlahos J, Hermantara R, Pratama MY, Ramkhelawon B. Mechanosignals in abdominal aortic aneurysms. Front Cardiovasc Med 2023; 9:1021934. [PMID: 36698932 PMCID: PMC9868277 DOI: 10.3389/fcvm.2022.1021934] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/29/2022] [Indexed: 01/11/2023] Open
Abstract
Cumulative evidence has shown that mechanical and frictional forces exert distinct effects in the multi-cellular aortic layers and play a significant role in the development of abdominal aortic aneurysms (AAA). These mechanical cues collectively trigger signaling cascades relying on mechanosensory cellular hubs that regulate vascular remodeling programs leading to the exaggerated degradation of the extracellular matrix (ECM), culminating in lethal aortic rupture. In this review, we provide an update and summarize the current understanding of the mechanotransduction networks in different cell types during AAA development. We focus on different mechanosensors and stressors that accumulate in the AAA sac and the mechanotransduction cascades that contribute to inflammation, oxidative stress, remodeling, and ECM degradation. We provide perspectives on manipulating this mechano-machinery as a new direction for future research in AAA.
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Affiliation(s)
- Christiana Lowis
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Biomedicine, Indonesia International Institute for Life-Sciences, Jakarta, Indonesia
| | - Aurellia Ramara Winaya
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Biomedicine, Indonesia International Institute for Life-Sciences, Jakarta, Indonesia
| | - Puja Kumari
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States
| | - Cristobal F. Rivera
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States
| | - John Vlahos
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States
| | - Rio Hermantara
- Department of Biomedicine, Indonesia International Institute for Life-Sciences, Jakarta, Indonesia
| | - Muhammad Yogi Pratama
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States,Muhammad Yogi Pratama,
| | - Bhama Ramkhelawon
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, United States,Department of Cell Biology, New York University Langone Medical Center, New York, NY, United States,*Correspondence: Bhama Ramkhelawon,
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16
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Fast and Accurate Computation of the Displacement Force of Stent Grafts after Endovascular Aneurysm Repair. Bioengineering (Basel) 2022; 9:bioengineering9090447. [PMID: 36134992 PMCID: PMC9495395 DOI: 10.3390/bioengineering9090447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/31/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: Currently, the displacement force of stent grafts is generally obtained using computational fluid dynamics (CFD), which requires professional CFD knowledge to perform the correct simulation. This study proposes a fast, simple, and clinician-friendly approach to calculating the patient-specific displacement force after endovascular aneurysm repair (EVAR). Methods: Twenty patient-specific post-EVAR computed tomography angiography images were used to reconstruct the patient-specific three-dimensional models, then the displacement forces were calculated using CFD and the proposed approaches, respectively, and their numerical differences were compared and analyzed. Results: Based on the derivation and simplification of the momentum theorem, the patient-specific displacement forces were obtained using the information of the patient-specific pressure, cross-sectional area, and angulation of the two stent graft ends, and the average relative error was no greater than 1.37% when compared to the displacement forces calculated by CFD. In addition, the linear regression analysis also showed good agreement between the displacement force values calculated by the new approach and CFD (R = 0.999). Conclusions: The proposed approach can quickly and accurately calculate the patient-specific displacement force on a stent graft and can therefore help clinicians quickly evaluate the post-EVAR displacement force.
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17
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Swedish snuff (snus) dipping, cigarette smoking, and risk of peripheral artery disease: a prospective cohort study. Sci Rep 2022; 12:12139. [PMID: 35840660 PMCID: PMC9287299 DOI: 10.1038/s41598-022-16467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Tobacco smoking is an important risk factor for peripheral artery disease (PAD), but it remains unknown whether smokeless tobacco, such as Swedish snuff (snus), is also associated with this disease. We used data from the Cohort of Swedish Men including 24,085 men. Individuals were grouped into never, past, and current snus dippers as well as never, past quitting ≥ 10 years, past, quitting < 10 years, and current smokers. Incident PAD cases were defined by linkage of the cohort with the Swedish National Patient Register. Cox proportional hazards regression was used to analyze the data. Over a mean follow-up period of 9.1 years (from July 1, 2009 to December 31, 2019), 655 incident PAD cases were ascertained. Cigarette smoking but not Swedish snus dipping was associated with an increased risk of PAD. Compared with never snus dippers, the hazard ratio of PAD was 0.95 (95% confidence interval [CI] 0.73–1.24) for past snus dippers and 0.88 (95% CI 0.66–1.17) for current snus dippers. Compared to never smokers, the hazard ratio of PAD was 1.38 (95% CI 1.14–1.68) for past smoker who stopped smoking for ≥ 10 years, 2.61 (95% CI 1.89–3.61) for past smoker who stopped smoking for < 10 years, and 4.01 (95% CI 3.17, 5.08) for current smoker. In conclusion, cigarette smoking but not Swedish snus dipping increases the risk of PAD.
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