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Zorrilla R, Soudah E. An efficient procedure for the blood flow computer simulation of patient-specific aortic dissections. Comput Biol Med 2024; 179:108832. [PMID: 39002313 DOI: 10.1016/j.compbiomed.2024.108832] [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: 03/12/2024] [Revised: 06/06/2024] [Accepted: 06/29/2024] [Indexed: 07/15/2024]
Abstract
In this work we present a novel methodology for the numerical simulation of patient-specific aortic dissections. Our proposal, which targets the seamless virtual prototyping of customized scenarios, combines an innovative two-step segmentation procedure with a CutFEM technique capable of dealing with thin-walled bodies such as the intimal flap. First, we generate the fluid mesh from the outer aortic wall disregarding the intimal flap, similarly to what would be done in a healthy aorta. Second, we create a surface mesh from the approximate midline of the intimal flap. This approach allows us to decouple the segmentation of the fluid volume from that of the intimal flap, thereby bypassing the need to create a volumetric mesh around a thin-walled body, an operation widely known to be complex and error-prone. Once the two meshes are obtained, the original configuration of the dissection into true and false lumen is recovered by embedding the surface mesh into the volumetric one and calculating a level set function that implicitly represents the intimal flap in terms of the volumetric mesh entities. We then leverage the capabilities of unfitted mesh methods, specifically relying on a CutFEM technique tailored for thin-walled bodies, to impose the wall boundary conditions over the embedded intimal flap. We tested the method by simulating the flow in four patient-specific aortic dissections, all involving intricate geometrical patterns. In all cases, the preprocess is greatly simplified with no impact on the computational times. Additionally, the obtained results are consistent with clinical evidence and previous research.
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Affiliation(s)
- Rubén Zorrilla
- Departament d'Enginyeria Civil i Ambiental, Universitat Politècnica de Catalunya (UPC), Barcelona, 08034, Spain; International Center for Numerical Methods in Engineering (CIMNE), Barcelona, 08034, Spain.
| | - Eduardo Soudah
- Departament de Resistència de Materials i Estructures a l'Enginyeria, Universitat Politècnica de Catalunya (UPC), Barcelona, 08034, Spain; International Center for Numerical Methods in Engineering (CIMNE), Barcelona, 08034, Spain; Departamento de Ciencia de los Materiales e Ingeniería Metalúrgica, Expresión Gráfica en la Ingeniería, Ingeniería Cartográfica, Geodésica y Fotogrametría, Ingeniería Mecánica e Ingeniería de los Procesos de Fabricación, Universidad de Valladolid (UVA), Valladolid, 47011, Spain.
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2
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Liang S, Jia H, Dong H, Li Z, Zhou G, Zhang X, Chen D, Xiong J. Hemodynamic Study of Stanford Type B Aortic Dissection Based on Ex Vivo Porcine Aorta Models. J Endovasc Ther 2022; 30:441-448. [PMID: 35249398 DOI: 10.1177/15266028221081089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: In this study, we aimed to evaluate hemodynamic influence of the dissected aortic system via various ex vivo type B aortic dissection (AD) models. Methods: Twenty-four raw porcine aortas were harvested and randomly divided into 4 groups to create various aortic models. Model A was the control group, while models B to D indicated the AD group, where models B and C presented a proximal primary entry with the false lumen (FL) lengths of 15 and 20 cm, respectively, and model D presented a 20 cm FL with a proximal primary entry and a distal reentry. All the aortic models were connected to a mock circulation loop to attain the realistic flow and pressure status. The flow distribution rate (FDR) of the aortic branches was calculated. Doppler ultrasound was applied to visualize the AD structure and to attain the velocity of flow in both the true and false lumens. Several sections of the AD were stained with hematoxylin and eosin for histologic evaluation after the experiment. Results: This study demonstrated that higher pressures were found for the AD group compared with the control group. The mean systolic pressures at the inlet of models A to D were 113.34±0.81, 120.58±0.52, 117.76±0.82, and 115.87±0.42 mm Hg, respectively. The FDRs of the celiac artery in models A to D were 8.65%, 8.32%±0.15%, 7.87%±0.13%, and 8.03%±0.21%, respectively. By ultrasound visualization, the velocity of the flow at the entry to the FL in the AD group ranged in 10 to 92 cm/s. The dissection flap presented pulsatile movement, especially in the models B and C which contained 1 primary entry without distal reentries. Histological examinations indicated that AD was located between the intimal and medial layers. Conclusions: Our ex vivo models demonstrated that the configuration of the dissected aorta influenced the pressure distribution. Moreover, the dissection flap affected the FDR of the aortic branches that possibly inducing malperfusion syndrome.
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Affiliation(s)
- Shichao Liang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Heyue Jia
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Huiwu Dong
- Department of Ultrasound Diagnosis, Chinese PLA General Hospital, Beijing, China
| | - Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Guojing Zhou
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Xuehuan Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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Franzetti G, Bonfanti M, Homer-Vanniasinkam S, Diaz-Zuccarini V, Balabani S. Experimental evaluation of the patient-specific haemodynamics of an aortic dissection model using particle image velocimetry. J Biomech 2022; 134:110963. [PMID: 35151036 PMCID: PMC9617468 DOI: 10.1016/j.jbiomech.2022.110963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 12/05/2021] [Accepted: 01/14/2022] [Indexed: 11/15/2022]
Abstract
Aortic Dissection (AD) is a complex pathology that affects the aorta. Diagnosis, management and treatment remain a challenge as it is a highly patient-specific pathology and there is still a limited understanding of the fluid-mechanics phenomena underlying clinical outcomes. Although in vitro models can allow the accurate study of AD flow fields in physical phantoms, they are currently scarce and almost exclusively rely on over simplifying assumptions. In this work, we present the first experimental study of a patient-specific case of AD. An anatomically correct phantom was produced and combined with a state-of-the-art in vitro platform, informed by clinical data, employed to accurately reproduce personalised conditions. The complex AD haemodynamics reproduced by the platform was characterised by flow rate and pressure acquisitions as well as Particle Image Velocimetry (PIV) derived velocity fields. Clinically relevant haemodynamic indices, that can be correlated with AD prognosis - such as velocity, shear rate, turbulent kinetic energy distributions - were extracted in two regions of interest in the aortic domain. The acquired data highlighted the complex nature of the flow (e.g. recirculation regions, low shear rate in the false lumen) and was in very good agreement with the available clinical data and the CFD results of a study conducted alongside, demonstrating the accuracy of the findings. These results demonstrate that the described platform constitutes a powerful, unique tool to reproduce in vitro personalised haemodynamic conditions, which can be used to support the evaluation of surgical procedures, medical devices testing and to validate state-of-the-art numerical models.
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Affiliation(s)
- Gaia Franzetti
- Department of Mechanical Engineering, University College London, London, UK
| | - Mirko Bonfanti
- Department of Mechanical Engineering, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Shervanthi Homer-Vanniasinkam
- Department of Mechanical Engineering, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Vanessa Diaz-Zuccarini
- Department of Mechanical Engineering, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Stavroula Balabani
- Department of Mechanical Engineering, University College London, London, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
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Brunet J, Pierrat B, Badel P. Review of Current Advances in the Mechanical Description and Quantification of Aortic Dissection Mechanisms. IEEE Rev Biomed Eng 2021; 14:240-255. [PMID: 31905148 DOI: 10.1109/rbme.2019.2950140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aortic dissection is a life-threatening event associated with a very poor outcome. A number of complex phenomena are involved in the initiation and propagation of the disease. Advances in the comprehension of the mechanisms leading to dissection have been made these last decades, thanks to improvements in imaging and experimental techniques. However, the micro-mechanics involved in triggering such rupture events remains poorly described and understood. It constitutes the primary focus of the present review. Towards the goal of detailing the dissection phenomenon, different experimental and modeling methods were used to investigate aortic dissection, and to understand the underlying phenomena involved. In the last ten years, research has tended to focus on the influence of microstructure on initiation and propagation of the dissection, leading to a number of multiscale models being developed. This review brings together all these materials in an attempt to identify main advances and remaining questions.
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Shiraishi Y, Yambe T, Narracott AJ, Yamada A, Morita R, Qian Y, Hanzawa K. Modeling Approach for An Aortic Dissection with Endovascular Stenting. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5008-5011. [PMID: 33019111 DOI: 10.1109/embc44109.2020.9176423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Repair of dissected aorta requires remodeling the structure of the media. Modeling approaches specific to endovascular stenting for aortic dissection have been reported. We created a goat model of descending thoracic aortic dissection and reproduced its morphological characteristics in a mock circulatory system. The purpose of this study was to examine a newly developed aortic stent which was capable of installing to the aortic dissected lesion for biomedical hemodynamics point of view. In this study, we examined the changes in hemodynamics of dissected lesions and the amelioration by endovascular stent intervention. Firstly, we performed animal experiments with the dissected aorta and examined the effects of stenting on volumetric changes in the false lumen. Secondly, we made several types of 3-D stereolithographic dissected aortic models with silicone rubber membrane between the false and the true lumens. Then, the hemodynamic characteristics in each model were evaluated in the pulsatile flow conditions in a mock circulatory system. These modelling approaches enabled the quantitative examination of post-therapeutic effects of stenting followed by elucidating of hemodynamic changes in the vicinity of stents, which may follow the management of clinical amelioration of interventional treatment with aortic stenting.Clinical Relevance- This study represents a modelling approach of the dissected aorta for endovascular intervention using stenting followed by the examination of false lumen volumetric changes resulting in the deterioration of pressure increase in diseased lesions.
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Computational modeling of the fluid flow in type B aortic dissection using a modified finite element embedded formulation. Biomech Model Mechanobiol 2020; 19:1565-1583. [PMID: 31974816 DOI: 10.1007/s10237-020-01291-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
This work explores the use of an embedded computational fluid dynamics method to study the type B aortic dissection. The use of the proposed technique makes it possible to easily test different intimal flap configurations without any need of remeshing. To validate the presented methodology, we take as reference test case an in vitro experiment present in the literature. This experiment, which considers several intimal flap tear configurations (number, size and location), mimics the blood flow in a real type B aortic dissection. We prove the correctness and suitability of the presented approach by comparing the pressure values and waveform. The obtained results exhibit a remarkable similarity with the experimental reference data. Complementary, we present a feasible surgical application of the presented computer method. The aim is to help the clinicians in the decision making before the type B aortic dissection surgical fenestration. The capabilities of the proposed technique are exploited to efficiently create artificial reentry tear configurations. We highlight that only the radius and center of the reentry tear need to be specified by the clinicians, without any need to modify neither the model geometry nor the mesh. The obtained computational surgical fenestration results are in line with the medical observations in similar clinical studies.
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Ryzhakov P, Soudah E, Dialami N. Computational modeling of the fluid flow and the flexible intimal flap in type B aortic dissection via a monolithic arbitrary Lagrangian/Eulerian fluid-structure interaction model. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3239. [PMID: 31336022 DOI: 10.1002/cnm.3239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023]
Abstract
In the present work, we perform numerical simulations of the fluid flow in type B aortic dissection (AD), accounting for the flexibility of the intimal flap. The interaction of the flow with the intimal flap is modeled using a monolithic arbitrary Lagrangian/Eulerian fluid-structure interaction model. The model relies on choosing velocity as the kinematic variable in both domains (fluid and solid) facilitating the coupling. The fluid flow velocity and pressure evolution at different locations is studied and compared against the experimental evidence and the formerly published numerical simulation results. Several tear configurations are analyzed. Details of the fluid flow in the vicinity of the tears are highlighted. Influence of the tear size upon the fluid flow and the flap deformation is discussed.
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Affiliation(s)
- Pavel Ryzhakov
- Centre Internacional de Mètodes Numèrics a l'Enginyeria, CIMNE, Barcelona, Spain
- Universitat Politècnica de Catalunya, UPC, Barcelona, Spain
| | - Eduardo Soudah
- Centre Internacional de Mètodes Numèrics a l'Enginyeria, CIMNE, Barcelona, Spain
- Universitat Politècnica de Catalunya, UPC, Barcelona, Spain
| | - Narges Dialami
- Centre Internacional de Mètodes Numèrics a l'Enginyeria, CIMNE, Barcelona, Spain
- Universitat Politècnica de Catalunya, UPC, Barcelona, Spain
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Guo B, Dong Z, Pirola S, Liu Y, Menichini C, Xu XY, Guo D, Fu W. Dissection Level Within Aortic Wall Layers is Associated with Propagation of Type B Aortic Dissection: A Swine Model Study. Eur J Vasc Endovasc Surg 2019; 58:415-425. [PMID: 31337584 DOI: 10.1016/j.ejvs.2019.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/22/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Haemodynamic and geometric factors play pivotal roles in the propagation of acute type B aortic dissection (TBAD). The aim of this study was to evaluate the association between dissection level within all aortic layers and the propagation of acute TBAD in porcine aorta. METHODS In twelve pigs, two models of TBAD were created. In model A (n = 6), the aortic wall tear was superficial and close to the intima (thin intimal flap), whereas in model B (n = 6) it was deep and close to the adventitia (thick intimal flap). Dissection propagation was evaluated using angiography or computed tomography scans, and the haemodynamic measurements were acquired using Doppler wires. Most pigs were followed up at 1, 3, 6, 12, 18, and up to 24 months; four animals were euthanised at three and six months, respectively (two from each group). RESULTS Both models were successfully created. No statistical difference was observed for the median antegrade propagation distance intra-operatively between the two models (p = .092). At 24 months, the longitudinal propagation distance was significantly greater in model B than in model A (p = .016). No statistical difference in retrograde propagation was noted (p = .691). Over time, aortic wall dissection progressed most notably over the first three months in model A, whereas it continued over the first 12 months in model B. Flow velocity was significantly greater in the true lumen than in false lumen at the level of the primary tear (p = .001) and in the middle of the dissection (p = .004). The histopathological images at three and six months demonstrated the fibres were stretched linearly at the outside wall of false lumen in both models, while the depth of intimal tears developed to be superficial and similar at the distal dissection. CONCLUSION In this swine model of TBAD, a deeper intimal tear resulted in greater dissection propagation.
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Affiliation(s)
- Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Zhihui Dong
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Yifan Liu
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China
| | - Claudia Menichini
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, South Kensington Campus, London, UK
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital Fudan University, Shanghai, China.
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Canchi S, Guo X, Phillips M, Berwick Z, Kratzberg J, Krieger J, Roeder B, Haulon S, Chambers S, Kassab GS. Role of Re-entry Tears on the Dynamics of Type B Dissection Flap. Ann Biomed Eng 2017; 46:186-196. [PMID: 29086223 PMCID: PMC5754433 DOI: 10.1007/s10439-017-1940-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/29/2017] [Indexed: 12/13/2022]
Abstract
Mortality during follow-up after acute Type B aortic dissection is substantial with aortic expansion observed in over 59% of the patients. Lumen pressure differential is considered a prime contributing factor for aortic dilation after propagation. The objective of the study was to evaluate the relationship between changes in vessel geometry with and without lumen pressure differential post propagation in an ex vivo porcine model with comparison with patient clinical data. A pulse duplicator system was utilized to propagate the dissection within descending thoracic porcine aortic vessels for set proximal (%circumference of the entry tear: 40%, axial length: 2 cm) and re-entry (50% of distal vessel circumference) tear geometry. Measurements of lumen pressure differential were made along with quantification of vessel geometry (n = 16). The magnitude of mean lumen pressure difference measured after propagation was low (~ 5 mmHg) with higher pressures measured in false lumen and as anticipated the pressure difference approached zero after the creation of distal re-entry tear. False lumen Dissection Ratio (FDR) defined as arc length of dissected wall divided by arc length of dissection flap, had mean value of 1.59 ± 0.01 at pressure of 120/80 mmHg post propagation with increasing values with increase in pulse pressure that was not rescued with the creation of distal re-entry tear (p < 0.01). An average FDR of 1.87 ± 0.27 was measured in patients with acute Type B dissection. Higher FDR value (FDR = 1 implies zero dissection) in the presence of distal re-entry tear demonstrates an acute change in vessel morphology in response to the dissection independent of local pressure changes challenges the re-apposition of the aortic wall.
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Affiliation(s)
- Saranya Canchi
- California Medical Innovations Institute, 11107 Roselle St., Rm. 211, San Diego, CA, 92121, USA
| | - Xiaomei Guo
- California Medical Innovations Institute, 11107 Roselle St., Rm. 211, San Diego, CA, 92121, USA
| | | | | | | | | | | | - Stephan Haulon
- Aortic Center, Hôpital Cardiologique, CHU de Lille, Lille, France
| | | | - Ghassan S Kassab
- California Medical Innovations Institute, 11107 Roselle St., Rm. 211, San Diego, CA, 92121, USA.
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Experimental Assessment of Physician Modified Proximal Scalloped Stent Graft to Extend Proximal Landing Zone in the Aortic Arch. Eur J Vasc Endovasc Surg 2017; 54:150-156. [DOI: 10.1016/j.ejvs.2017.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/24/2017] [Indexed: 11/24/2022]
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Veger HTC, Pasveer EH, Visser MJT. Where to Fenestrate in Aortic Dissection Type B? An Ex Vivo Study. Ann Vasc Surg 2017; 43:296-301. [DOI: 10.1016/j.avsg.2017.03.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 02/21/2017] [Accepted: 03/26/2017] [Indexed: 11/28/2022]
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Nauta FJH, Conti M, Kamman AV, van Bogerijen GHW, Tolenaar JL, Auricchio F, Figueroa CA, van Herwaarden JA, Moll FL, Trimarchi S. Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection. J Endovasc Ther 2015; 22:918-33. [DOI: 10.1177/1526602815608848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.
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Affiliation(s)
- Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Jip L. Tolenaar
- Department of General Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - C. Alberto Figueroa
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
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Iranmanesh S, Ricotta JJ. Current management of acute type B aortic dissection. World J Surg Proced 2015; 5:208-216. [DOI: 10.5412/wjsp.v5.i2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/23/2015] [Accepted: 04/02/2015] [Indexed: 02/06/2023] Open
Abstract
Acute type B aortic dissection (TBAD) occurs as a result of an intimal tear within the proximal thoracic aorta. Patients are typically managed acutely with aggressive antihypertensive therapy. Surgical repair is reserved for those who develop complications such as rupture or malperfusion. The surgical management of acute TBAD has changed considerably in the last decade secondary to the advent of thoracic stent grafting. Thoracic endovascular aortic repair (TEVAR) has improved early mortality and morbidity rates for patients presenting with complicated TBAD. The role of TEVAR in patients presenting with acute and subacute uncomplicated TBAD is less clear. TEVAR has been associated with increased late survival and better aortic remodeling, with low perioperative morbidity in selected patients. Recent literature suggests certain radiographic criteria may be used to predict patients developing late aortic events who would benefit from early TEVAR. The purpose of this article is to review the contemporary management of acute TBAD, discuss controversies in management and evaluate the latest research findings.
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The Role of Branch Vessels in Aortic Type B Dissection: An in vitro Study. Eur J Vasc Endovasc Surg 2015; 49:375-81. [DOI: 10.1016/j.ejvs.2014.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022]
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