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Pintaric K, Boltezar L, Umek N, Kuhelj D. Long-term outcome of multilayer flow modulator in aortic aneurysms. Radiol Oncol 2024; 58:206-213. [PMID: 38613840 PMCID: PMC11165975 DOI: 10.2478/raon-2024-0021] [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: 01/12/2024] [Accepted: 02/20/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND This retrospective study investigated the efficacy of endovascular treatment with multilayer flow modulators (MFMs) for treating aortic aneurysms in high-risk patients unsuitable for conventional treatments. PATIENTS AND METHODS Conducted from 2011 to 2019 at a single center, this retrospective observational study included 17 patients who underwent endovascular treatment with MFMs. These patients were selected based on their unsuitability for traditional surgical or endovascular procedures. The study involved meticulous pre-procedural planning, precise implantation of MFMs, and follow-up using CT angiography. The primary focus was on volumetric and flow volume changes in aneurysms, along with traditional diameter measurements. Moreover, the technical success and post-procedural complications were also registered. RESULTS The technical success rate was 100%, and 30-day procedural complication rate was 17.6%. Post-treatment assessments revealed that 11 out of 17 patients showed a decrease in flow volume within the aneurysm sac, indicative of a favorable hemodynamic response. The median decrease in flow volume was 12 ml, with a median relative decrease of 8%. However, there was no consistent reduction in aneurysm size; most aneurysms demonstrated a median increase in volume for 46 ml and median increase in diameter for 18 mm. CONCLUSIONS While MFMs offer a potential alternative for high-risk aortic aneurysm patients, their effectiveness in preventing aneurysm expansion is limited. The results suggest that MFMs can provide a stable hemodynamic environment but do not reliably reduce aneurysm size. This underscores the need for ongoing vigilance and long-term monitoring in patients treated with this technology.
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Affiliation(s)
- Karlo Pintaric
- Clinical Institute of Radiology, University Medical Center Ljubljana, Slovenia
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Lucka Boltezar
- Department of Medical Oncology, Institute of Oncology Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Nejc Umek
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute of Radiology, University Medical Center Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
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2
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Teng B, Chen Z, Ao Y, Zhao Y, Li F, Fu Q, Zhang W, Wang Z. One year follow-up outcomes of endovascular treatment for aortic dissection with a partial micropore stent graft in which fixation of the stent is done in zone 0: A pivotal trial first in human. Eur J Radiol 2023; 161:110720. [PMID: 36774671 DOI: 10.1016/j.ejrad.2023.110720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to verify the efficacy and safety of the treatment for patients diagnosed with DeBakey type I and type III thoracic aortic dissections using a partial micropore stent graft. METHODS We conducted a retrospective analysis of 32 patients who suffered from thoracic aortic dissection and underwent endovascular repair using a partial micropore stent graft at our center between December 2018 and January 2020. RESULTS The technical success rate for 32 patients was 100 %, while no 30-day mortality was observed. In the 30 patients finished follow-ups, 30 (mean: 1 per patient) micropore stents were implanted, while the openings of 90 (mean: 3 per patient) aortic arch branches were covered by the stents. After more than 12 months follow-up, 26 (86.7 %) of the 30 patients presented with a complete thrombosis in the false lumen, and 4 (13.3 %) patients presented with a partial thrombosis in the false lumen. All 90 aortic arch branches were patent. No aortic arch branch artery stenosis or occlusion was observed. CONCLUSIONS The outcomes obtained during 12 months of follow-up suggested that performing endovascular repair for thoracic aortic dissection patients with a partial micropore stent graft is safe and effective, maintaining the patency of aortic arch branch vessels.
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Affiliation(s)
- Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Zhen Chen
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yuxiang Ao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Qining Fu
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Wei Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Zhe Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Wang G, Li Z, Chen C, Yan F, Wei J, Zhang Z, Chen Y. The hemodynamic effect of eccentricity in visceral branched aneurysms with multilayer stents. Proc Inst Mech Eng H 2022; 236:1070-1079. [DOI: 10.1177/09544119221106829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is preliminarily acknowledged that multilayer stent (MS) is a promising alternative technology in the treatment of visceral branched aneurysms, but hemodynamic consequences of eccentricity in such aneurysms with MS are less examined. In this work, we performed a time-dependent simulation of branched aneurysms of various eccentricities with different stent layers, and thrombosis-related parameters, such as time-averaged wall shear stress (TAWSS), oscillating shear index (OSI), and relative residence time (RRT), were also analyzed. Our results revealed that MS can generally restore laminar flow inside the stent, and allow proper perfusion to vital organs while also fostering a relatively secluded hemodynamic environment for thrombosis formation. Particularly, a flow in the aneurysm sac communicating between the main artery and side branch forms at early systole. However, MS fails to completely eliminate detrimental flow impingement after peak systole, which may hinder aneurysm recovery, especially in the cases of eccentric aneurysms. Therefore, saccular aneurysms should be treated with more caution than fusiform aneurysms. And further therapeutic attempts to keep both perfusion in the proximal region of the aneurysm and isolation in the distal region of the aneurysm should be considered.
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Affiliation(s)
- Guanshi Wang
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Zhongyou Li
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Chong Chen
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Fei Yan
- Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Junru Wei
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
| | - Zhuo Zhang
- College of Mechanical Engineering, Sichuan University, Chengdu, China
| | - Yu Chen
- Laboratory of Biomechanical Engineering, Department of Applied Mechanics, College of Architecture and Environment, Sichuan University, Chengdu, China
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Zhang Y, Lu Q, Zhang S, Liang Z, Cui J, Jing Z. Endovascular treatment of complicated aortic aneurysms using a modified flow-diverting strategy: Mid- to long-term outcome from a multicenter cohort study. Br J Radiol 2022; 95:20210859. [PMID: 35180007 PMCID: PMC10993961 DOI: 10.1259/bjr.20210859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/29/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Frequently reported adverse events following flow-diverting stents' treatment of aortic aneurysms indicate further refinements of this technique are required. This study aims at evaluating the clinical efficacy of an improved flow-diverting strategy. METHODS A modified flow-diverting procedure was utilized in selected patients, in which stent-grafts were used to cover the non-branched segment of the aneurysmal lesion while flow-diverting multilayered bare metal stents were applied to cover the reno-visceral segment. The safety and efficacy of this joint procedure were assessed by regular follow-up. RESULTS We screened 497 patients and included 67 cases (mean age: 67.07 ± 12.14 years; 53 males) between February 2012 and March 2018. The median number of stent-grafts and bare metal stents used in the procedure were 1 (range: 1 to 3) and 3 (range: 2 to 4), respectively. During a mean follow-up period of 34.54 ± 20.28 months, aneurysm maximum diameter decreased from 64.79 ± 10.31 to 59.32 ± 10.20 mm (p = 0.002), while sac thrombosis ratio increased from 26.01±10.99% to 98.46±4.84% (p<0.001). Aneurysm-related death or conversion to open repair was documented in three patients. The majority side-branches (198/201) remained patent during follow-up. Overall clinical success rate reached 91.04% (61/67). CONCLUSIONS The joint procedure is characterized by significant aneurysm thrombosis along with high aneurysm stabilization/shrinkage and side-branches' patency rate. It might represent a potential improvement of the flow-diverting strategy in treating complex aortic lesions, yet large-scale, prospective, and randomized trials are anticipated to draw a robust conclusion. ADVANCES IN KNOWLEDGE The joint procedure could potentially exclude complex aortic aneurysms from circulation while maintaining the collateral branches.
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Affiliation(s)
- Yongxue Zhang
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
| | - Simeng Zhang
- Department of Pediatric Cardiac Surgery, State Key Laboratory
of Cardiovascular Disease, Fuwai Hospital,
Beijing, China
| | - Zhihui Liang
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International
Peace Hospital, Shijiazhuang,
China
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai
Hospital, Shanghai,
China
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Salvati S, Bilman V, Melloni A, Baccellieri D, Kahlberg A, Melissano G, Chiesa R, Bertoglio L. Late surgical conversion of failed Multilayer Flow Modulator stenting in thoraco-abdominal aneurysms. Interact Cardiovasc Thorac Surg 2022; 34:111-119. [PMID: 34999791 PMCID: PMC8923416 DOI: 10.1093/icvts/ivab224] [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: 03/25/2021] [Revised: 05/27/2021] [Accepted: 07/13/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to report the outcomes of open or hybrid repair of failed thoraco-abdominal aortic aneurysm endovascular treatment with Multilayer Flow Modulator (MFM) stents. METHODS All patients who underwent open or hybrid repair of a failed MFM aortic treatment were retrospectively analysed. Perioperative and postoperative data, as well as midterm survival, were assessed. RESULTS Between 2013 and 2020, 39 patients received an open or hybrid conversion after endovascular treatment. Five of them [13%; 4 males; median age 68 years (interquartile range 66-76)] were previously treated with aortic MFM stents (Cardiatis, Isnes, Belgium). Among these, the median interval between index repair and conversion was 84 months (interquartile range 75-84). The median aneurysm diameter was 9.6 cm (interquartile range 8-10). Renovisceral vessels steno-occlusion was highly prevalent: 2 renal arteries were occluded; 3 coeliac trunks, 2 renal arteries and 1 superior mesenteric artery had a >70% ostial stenosis. Open standard thoraco-abdominal aneurysm conversion was performed in 3 fit patients, while a hybrid approach with visceral debranching and tube endografting was performed in 2 high-risk patients. Two patients (2 open repairs) died intraoperatively, and 1 (hybrid repair) postoperatively. The 2 successfully treated patients are alive at 4- and 34-month follow-up, respectively, with patent visceral branches. CONCLUSIONS Open or hybrid thoraco-abdominal aortic aneurysm treatment after failed endovascular aortic repair with MFM stents might be the only surgical option to address sac enlargements and ruptures or branch-related failures. However, both procedures had a poor prognosis due to both the impaired preoperative patient's status and the surgical complexity in the presented series.
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Affiliation(s)
- Simone Salvati
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Victor Bilman
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Andrea Melloni
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Domenico Baccellieri
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Andrea Kahlberg
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Germano Melissano
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Roberto Chiesa
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
| | - Luca Bertoglio
- Division of Vascular Surgery, IRCCS San Raffaele Scientific Institute, “Vita-Salute” University, Milan, Italy
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Massara M, Alberti A, Cutrupi A, Alberti V, Franco G, Volpe P. A Case of Multilevel Aortic Disease Treated Using Cardiatis Multilayer Flow Modulator. Ann Vasc Dis 2021; 14:264-266. [PMID: 34630771 PMCID: PMC8474089 DOI: 10.3400/avd.cr.21-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
A recent systematic review and meta-analysis shows that synchronous and metachronous thoracic and abdominal aortic aneurysms are present in 19.2% of cases. The management remains controversial: elective simultaneous TEVAR and EVAR could increase morbidity due to increased aortic coverage during a single procedure, longer operative times, increased blood loss, and greater contrast exposure. Conversely, simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysms repair (EVAR) prevent the need for two interventions, reduces future access site complications, and obviates interval aortic complications. We present a case of a multilevel aortic disease treated in three stages: EVAR, TEVAR, and exclusion of an increasing aortic visceral penetrating aortic ulcer through a multilayer flow modulator endograft with an optimal result.
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Affiliation(s)
- Mafalda Massara
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Antonino Alberti
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Andrea Cutrupi
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Vittorio Alberti
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Gaetana Franco
- Intensive Care Unit, Emergency-Urgency Department, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Pietro Volpe
- Unit of Vascular and Endovascular Surgery, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
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7
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Bontinis V, Antonopoulos CN, Bontinis A, Sfyroeras GS, Kontopodis N, Ioannou CV, Ktenidis K, Geroulakos G. A systematic review and meta-analysis of the streamliner multilayer flow modulator stent for treatment of complex aortic lesions. J Vasc Surg 2021; 74:646-656.e9. [PMID: 34019986 DOI: 10.1016/j.jvs.2021.03.031] [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: 09/20/2020] [Accepted: 03/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated the safety and efficacy of multilayer flow modulator (MFM) stents (Cardiatis, Isnes, Belgium) for the treatment of complex aortic lesions. METHODS A systematic electronic research was conducted for studies reported from December 2008 to May 2020. Data extracted from 15 eligible case series (CS) were appropriately pooled and analyzed in a meta-analysis. The patient baseline characteristics were recorded, and 16 outcomes of interest were studied. The primary end points included 30-day all-cause and aneurysm-related mortality, aneurysm-related mortality at 1 year, vessel patency, and any endoleaks, ruptures, reinterventions, and aneurysm exclusion at the end of follow-up. RESULTS A total of 39 studies (15 CS and 24 case reports), involving 429 patients, met the inclusion criteria. Overall, 436 lesions were treated, and 1521 aortic branches were covered by the multilayer stent. The mean follow-up for the 15 CS with 404 patients was 14.6 months. Compliance with the instructions for use was reported by eight CS, with 75% of the procedures performed within the instructions for use. However, 41% of the patients reported by 12 CS had undergone a previous aortic intervention. The pooled 30-day all-cause and 30-day aneurysm-related mortality rates were 0.56% (95% confidence interval [CI], 0.00%-2.54%) and 0.00% (95% CI, 0.00%-0.80%), respectively. The pooled aneurysm-related mortality at 1 year of follow-up was 5.25% (95% CI, 0.07%-14.91%). The pooled vessel patency at the end of follow-up was 99.12% (95% CI, 97.73%-99.93%). The pooled reintervention and endoleak rates at the end of follow-up were 10.94% (95% CI, 3.64%-20.67%) and 10.70% (95% CI, 4.45%-18.66%), respectively. The crude spinal cord ischemia and renal failure rates were 0.69% and 1.8%, respectively. CONCLUSIONS The results from the present review and meta-analysis have indicated the safety and efficacy of MFM stents for treating challenging aortic pathologic lesions when used as first-line treatment and within the instructions for use. The almost zero pooled 30-day all-cause and aneurysm-related mortality rates combined with the low crude spinal cord ischemia and renal failure rates indicate the use of MFM stents is a good treatment option for complex aortic lesions in the short- and mid-term periods. The lack of long-term follow-up warrants further research concerning the efficacy of the device in the long term.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George S Sfyroeras
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George Geroulakos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Tupin S, Takase K, Ohta M. Experimental Analysis of Pressure and Flow Alterations During and After Insertion of a Multilayer Flow Modulator into an AAA Model with Incorporated Branch. Cardiovasc Intervent Radiol 2021; 44:1251-1259. [PMID: 33907900 DOI: 10.1007/s00270-021-02835-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/30/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The multilayer flow modulator (MFM) device has been used for the treatment of abdominal aortic aneurysm (AAA) for over a decade. Although several clinical studies have been published, criticism and concern over the device efficacy remain, as no quantitative analysis that describes its mechanism has been performed yet. The aim of this study was to experimentally evaluate the effect of MFM device deployment on aneurysmal pressure and branch perfusion. MATERIALS AND METHODS An experimental flow and pressure monitoring system was developed to analyze the MFM deployment procedure performed by a qualified radiologist in AAA geometries with and without side branch. Particle image velocimetry experiments were then conducted on models with and without MFM device to evaluate and compare flow patterns and local flow velocity and vorticity in the aneurysm. RESULTS The experiments revealed no significant change in pressure and flow rate during and after deployment of the MFM device. The flow rate of the incorporated branch was fully preserved. On both models, the aneurysmal flow velocity was significantly reduced. In addition, the device modified local flow patterns, reducing vorticity and better feeding the incorporated branch. CONCLUSION This experimental study provides the basis for a better understanding of the mechanism of the MFM device, which allows intra-aneurysmal flow to decrease while preserving incorporated branch flow and reducing the risk of type II endoleak. The experimental system developed for this study was effective in simulating an endovascular procedure and studying the safety and effectiveness of endovascular devices.
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Affiliation(s)
- Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan.
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai, Miyagi, 980-8577, Japan
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Song C, Cai Q, Huang Y, Lu Q. Multilayer bare stent technique in treating intact mycotic suprarenal aortic aneurysm: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33442625 PMCID: PMC7793158 DOI: 10.1093/ehjcr/ytaa361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/14/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
Background Invasive aspergillosis (IA) related mycotic aortic aneurysm is rare in immunocompetent patient. The endovascular therapy remains controversial due to potential risk of graft infection, while the suprarenal cases might face catastrophic complications during open surgery. Case summary We presented an IA case with suprarenal abdominal aortic aneurysm confirmed by joint effusion. Multilayer bare stent technique was performed to preserve visceral blood flow and promote aneurysmal thrombus formation, along with antifungal treatment. Two years of follow-up revealed complete aneurysm thrombosis without evidence of infection. Discussion Fungal infection that affects the aorta is difficult to recognize due to often negative blood cultures. Close observation is recommended in case of suspicion of mycotic aneurysms. Multilayer bare stent technique can restore luminal laminar blood flow and reduce the risk of infection in intact mycotic suprarenal aortic aneurysm.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200082, People's Republic of China
| | - Qing Cai
- Department of Department of Rheumatology and Immunology, Shanghai Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Yi Huang
- Department of Respiratory Medicine, Shanghai Changhai Hospital, Navy Medical University, Shanghai, People's Republic of China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Navy Medical University, Shanghai 200082, People's Republic of China
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Vento V, Lejay A, Kuntz S, Ancetti S, Heim F, Chakfé N, Gargiulo M. Current status on aortic endografts. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:544-554. [PMID: 32964901 DOI: 10.23736/s0021-9509.20.11614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Endovascular treatment has become widespread to treat aneurysmal disease, especially located in the aorta. The modern era of abdominal aortic aneurysm repair started between 1986 and 1991, and in the last 30 years, Endovascular Treatment for abdominal aortic aneurysms evolved both due to the development of new materials and devices and the increasing appeal and effectiveness of the endovascular therapy itself. Vascular surgeons are using nowadays different solutions of Endovascular Treatment to treat all the expressions of aortic pathology (aneurysms, dissections and trauma) both in the acute and elective setting. Despite its use in every location of the aorta (the ascending aorta, the aortic arch, the thoracic aorta, thoraco-abdominal aorta, pararenal, iuxtarenal and infrarenal aortic aneurysms and iliac aneurysms), its safety and efficiency, endovascular treatment for aortic aneurysms presents some drawbacks: despite a lower short-term morbi-mortality, reinterventions and long-term patency are higher compared to open repair. In this review, we detail the most used types of endografts according to location, their performances and durability for each device. We conclude by discussing options to overcome ET limitations. Therefore, an obvious question arises: what we need in the future? What can the technological progress gives to physicians to further improve this new way of treating aorta?
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Affiliation(s)
- Vincenzo Vento
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy.,Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Stefano Ancetti
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy
| | - Frédéric Heim
- Laboratory of Physics and Textile Mechanics, University of Upper Alsace, Mulhouse, France
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
| | - Mauro Gargiulo
- Unit of Vascular Surgery, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Polyclinic, University of Bologna, Bologna, Italy -
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11
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Spanos K, Kölbel T. Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection. Cardiovasc Intervent Radiol 2020; 43:1808-1820. [PMID: 32601718 PMCID: PMC8490267 DOI: 10.1007/s00270-020-02566-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/20/2020] [Indexed: 12/22/2022]
Abstract
In recent guidelines of international societies, the most frequent indication for treatment after chronic type B aortic dissection (cTBAD) is aneurysmal dilatation. Endovascular repair is recommended in patients with moderate to high surgical risk or with contraindications to open repair. During the last decade, many advances have been made in the field of endovascular techniques and devices. The aim of this article is to address the current status of endoluminal techniques for the management of cTBAD including standard thoracic endovascular repair, new devices, fenestrated and branched abdominal aortic devices and false lumen occlusion techniques.
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Affiliation(s)
- Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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12
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Zhang Y, Huang Y, Teng Z, Cui J, Lu Q, Jing Z. Biomechanical insight of the stent-induced thrombosis following flow-diverting strategy in the management of complicated aortic aneurysms. INT ANGIOL 2020; 40:52-59. [PMID: 32594671 DOI: 10.23736/s0392-9590.20.04447-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The flow-diverting stent (FDS) emerges as an alternative strategy in treating complicated aortic aneurysms. However, the biomechanical behavior of the stent-induced thrombus (SIT) remains little understood. This study sought to investigate the impact of SIT on aneurysm wall stress and strain distribution and offer basic evidences for its large-scale application. METHODS Aortic aneurysms treated with FDS and followed up over 5 years were selected. Case-specific models were created based on the pre-operative and 12 months follow-up imaging. The aortic central line was generated, perpendicular to which the slice with maximum aneurysm diameter was selected for two-dimensional modeling. Pre- and post-stenting models were compared, with emphasis laid on wall stress distribution and risk factors leading to local stress concentration. Clinical follow-up data was recorded to verify the biomechanical findings. RESULTS A total of 6 cases (3 females, average age 56.3±17.2 years) were enrolled in this study. Complete sac thrombosis was documented in 5 cases at 12 months, while residual perfusion was seen in the remaining one. With the formation of SIT, the average wall tensile stress dropped from 58.60±11.11 KPa to 23.56±12.05 KPa (P=0.001) at diastolic phase, and from 88.00±15.94 KPa to 36.02±18.31 KPa (P=0.001) at systolic phase. Intra-wall calcium plaque and irregular, spontaneous intraluminal thrombus were recognized as risk factors for local stress concentration, which could be mitigated by the regular, well-organized SIT. Long-term follow-up at 5 years showed significant aneurysm shrinkage from 57.7±16.2 mm to 51.0±13.7 mm (P=0.009). CONCLUSIONS The formation of SIT after FDS implantation might protect the aneurysm by reducing the wall tensile stress and erasing the local stress concentration. Clinical follow-up data seems to support the biomechanical role of SIT, but a larger study cohort is needed. A comprehensive understanding of SIT including both biomechanical and biological perspectives is warranted to draw an exhaustive conclusion.
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Affiliation(s)
- Yongxue Zhang
- Department of Surgery, Handan Medical Center, Bethune International Peace Hospital, Handan, China.,Department of Interventional Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Yuan Huang
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Jinguo Cui
- Department of Interventional Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China -
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Shanghai, China
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13
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Liang NL, Mohapatra A, Avgerinos ED, Katsargyris A. Acute Kidney Injury after Complex Endovascular Aneurysm Repair. Curr Pharm Des 2020; 25:4686-4694. [DOI: 10.2174/1381612825666191129095829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/25/2020] [Indexed: 11/22/2022]
Abstract
Background:
Complex endovascular repair of abdominal aortic aneurysm carries higher perioperative
morbidity than standard infrarenal endovascular repair.
Objective:
This study reviews the incidence and associated factors of acute kidney injury in complex aortic endovascular
repair of juxtarenal, pararenal, and thoracoabdominal aortic aneurysms.
Methods:
A literature review was performed for all studies on the endovascular repair of juxtarenal, pararenal,
and thoracoabdominal aneurysms that evaluated rates of acute kidney injury as an outcome. Outcomes were further
analyzed by the level of anatomic complexity and method of repair.
Results:
52 studies met inclusion criteria, with a total of 5454 individuals undergoing repair from 2004 to 2017.
The overall rate of acute kidney injury ranged widely from 0 to 41%, with a rate of hemodialysis from 0 to 19%
(temporary) and 0 to 14% (permanent). Increasing anatomic complexity was associated with higher rates of acute
kidney injury. Mode of endovascular repair, learning curve effect, and preoperative chronic renal insufficiency
did not demonstrate any associations with the outcome.
Conclusion:
Published rates of acute kidney injury in complex aortic aneurysm repair vary widely with few definitively
associated factors other than increasing anatomic complexity and operative time. Further study is
needed for the identification of predictors related to postoperative acute kidney injury.
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Affiliation(s)
- Nathan L. Liang
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, Penn, United States
| | - Abhisekh Mohapatra
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, Penn, United States
| | - Efthymios D. Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh PA, Penn, United States
| | - Athanasios Katsargyris
- Department of Vascular and Endovascular Surgery, Paracelsus Medical University Nuremberg, General Hospital Nuremberg, Nuremberg, Germany
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14
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Abdul Jabbar A, Chanda A, White CJ, Jenkins JS. Percutaneous endovascular abdominal aneurysm repair: State‐of‐the art. Catheter Cardiovasc Interv 2019; 95:767-782. [DOI: 10.1002/ccd.28576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/27/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Ali Abdul Jabbar
- Interventional CardiologyOchsner Clinic Foundation New Orleans Louisiana
| | - Arijit Chanda
- Interventional CardiologyOchsner Clinic Foundation New Orleans Louisiana
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15
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Predictor of false lumen thrombosis after thoracic endovascular aortic repair for type B dissection. J Thorac Cardiovasc Surg 2019; 160:360-367. [PMID: 31558276 DOI: 10.1016/j.jtcvs.2019.07.091] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/06/2019] [Accepted: 07/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Thoracic endovascular aortic repair of type B aortic dissection initiates thrombosis in the false lumen, which eventually results in aortic remodeling. We aimed to determine whether the false lumen thrombosis rate (FLTR) after thoracic endovascular aortic repair can be accurately predicted by an index that expresses the degree of aortic arch angulation. METHODS The geometry of 48 patients with acute type B aortic dissection (mean age, 48 years) after thoracic endovascular aortic repair was reconstructed from postoperative computed tomography images. We introduced a novel angle-the degree of question mark (φ)-to indicate the aortic morphology. Moreover, how aortic angulation influenced the FLTR was investigated based on hemodynamic parameters. Finally, a predicted mathematical model relating FLTR to aortic angulation was proposed, and 10 patients were chosen to validate the model. RESULTS The degree of question mark shape was shown to negatively correlate with FLTR (n = 38; P < .001; R = -0.661), and the linear relationship model was created as follows: FLTR (%) = -1.955 × φ + 168.24 (R2 = 0.437; P < .001). In addition, the net flow rate to the false lumen significantly increased with the increase of the degree of the question mark shape of the aorta. Furthermore, the difference and concordance of the proposed prediction model were perfectly validated in the remaining 10 patients using paired-sample t test and the concordance correlation coefficient. CONCLUSIONS The size of the question mark shape may be a good predictor for FLTR of acute type B aortic dissection following thoracic endovascular aortic repair. The higher the degrees of the question mark, the less likely it was to form a complete thrombus.
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16
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Li Z, Hu L, Chen C, Wang Z, Zhou Z, Chen Y. Hemodynamic Performance of Multilayer Stents in the Treatment of Aneurysms with a Branch Attached. Sci Rep 2019; 9:10193. [PMID: 31308428 PMCID: PMC6629690 DOI: 10.1038/s41598-019-46714-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/04/2019] [Indexed: 11/09/2022] Open
Abstract
Although multilayer stents (MSs) can be used to treat aneurysm effectively, for some aneurysms with branches attached, the hemodynamic mechanisms are still unclear. In this work, we modeled five cases that involve 1-4-layer stents implanted in aneurysms with side branches, and the numerical approach was used. Case 1 corresponds to an aneurysm without a stent, and cases 2-5 represent 1-4-layer stents being employed within aneurysms, respectively. The results showed that the velocity within the sac declined dramatically and the eddies' intensity weakened with increased number of stent layers, time-averaged wall shear stress (TAWSS), and nitric oxide production rate (TARNO) dropped linearly with increase in stent porosity, and oscillatory shear index (OSI) and relative residence time (RRT) increased evidently with MS intervention. Moreover, the MSs had a slight effect on the patency of the side branch; its flow rate was still above the normal case than without aneurysm. It can be concluded that MSs are helpful in promoting the growth of thrombus within the aneurysm through an isolated hemodynamic environment and keeping the branch unobstructed, but more clinical evidences are required.
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Affiliation(s)
- Zhongyou Li
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Lijuan Hu
- Third Department of Internal Medicine, Friendship Hospital, Xi'an, 710072, China
| | - Chong Chen
- College of Manufacturing Science & Engineering, Sichuan University, Chengdu, 610065, China
| | - Zhenze Wang
- Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs & Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Zhihong Zhou
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China.
| | - Yu Chen
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
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17
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Law Y, Kölbel T, Detter C, Rohlffs F, von Kodolitsch Y, Makaloski V, Debus ES, Tsilimparis N. Emergency Use of Branched Thoracic Endovascular Repair in the Treatment of Aortic Arch Pathologies. Ann Thorac Surg 2019; 107:1799-1806. [DOI: 10.1016/j.athoracsur.2018.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/21/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
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18
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Vignau Cano JM, Daroca Martínez T, Gómez Vidal M, Bermúdez García A, Macías Rubio D. Tratamiento endovascular de aneurisma en arco aórtico usando la endoprótesis multicapa moduladora de flujo. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Rikhtegar Nezami F, Athanasiou LS, Amrute JM, Edelman ER. Multilayer flow modulator enhances vital organ perfusion in patients with type B aortic dissection. Am J Physiol Heart Circ Physiol 2018; 315:H1182-H1193. [PMID: 30095992 DOI: 10.1152/ajpheart.00199.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Management of aortic dissections (AD) is still challenging, with no universally approved guideline among possible surgical, endovascular, or medical therapies. Approximately 25% of patients with AD suffer postintervention malperfusion syndrome or hemodynamic instability, with the risk of sudden death if left untreated. Part of the issue is that vascular implants may themselves induce flow disturbances that critically impact vital organs. A multilayer mesh construct might obviate the induced flow disturbances, and it is this concept we investigated. We used preintervention and post-multilayer flow modulator implantation (PM) geometries from clinical cases of type B AD. In-house semiautomatic segmentation routines were applied to computed tomography images to reconstruct the lumen. The device was numerically reconstructed and adapted to the PM geometry concentrically fit to the true lumen centerline. We also numerically designed a pseudohealthy case, where the geometry of the aorta was extracted interpolating geometric features of preintervention, postimplantation, and published representative healthy volunteers. Computational fluid dynamics methods were used to study the time-dependent flow patterns, shear stress metrics, and perfusion to vital organs. A three-element Windkessel lumped parameter module was coupled to a finite-volume solver to assign dynamic outlet boundary conditions. Multilayer flow modulator not only significantly reduced false lumen blood flow, eliminated local flow disturbances, and globally regulated wall shear stress distribution but also maintained physiological perfusion to peripheral vital organs. We propose further investigation to focus the management of AD on both modulation of blood flow and restoration of physiologic end-organ perfusion rather than mere restoration of vascular lamina morphology. NEW & NOTEWORTHY The majority of aortic dissection modeling efforts have focused on the maintenance of physiological flow using minimally invasive placed grafts. The multilayer flow modulator is a complex mesh construct of wires, designed to eliminate flow disruptions in the lumen, regulate the physiological wall stresses, and enhance endothelial function and offering the promise of improved perfusion of vital organs. This has never been fully proved or modeled, and these issues we confirmed using a dynamic framework of time-varying arterial waveforms.
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Affiliation(s)
- Farhad Rikhtegar Nezami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology , Cambridge, Massachusetts
| | - Lambros S Athanasiou
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology , Cambridge, Massachusetts.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Junedh M Amrute
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology , Cambridge, Massachusetts.,Division of Biology and Biological Engineering, California Institute of Technology , Pasadena, California
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology , Cambridge, Massachusetts.,Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
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