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Mei Y, Xu H, Ma W, Li Z, Yang R, Yuan H, Peng Y, Wu M, Chen Z, Guo W, Gao T, Xiong J, Chen D. Retrograde branched extension limb assembling stent of pararenal abdominal aortic aneurysm: A longitudinal hemodynamic analysis for stent graft migration. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3394. [PMID: 32790046 DOI: 10.1002/cnm.3394] [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: 08/14/2019] [Revised: 03/31/2020] [Accepted: 08/02/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Pararenal abdominal aortic aneurysms (PRAAAs) are a life-threatening disease, and hemodynamic analysis may provide greater insight into the effectiveness and long-term outcomes of endovascular aneurysm repair (EVAR). However, the lack of patient-specific boundary conditions on the periphery compromises the accuracy. Windkessel (WK) boundary conditions coupled to hemodynamic follow-up models of a PRAAA patient, aims to provide insights into the link between hemodynamics and poor prognosis. METHOD One PRAAA patient underwent EVAR and reintervention after one branch of stent-graft (SG) had migrated. Totally five computational follow-up models were studied. Patient-specific flow data acquired via ultrasound were used to define the boundary conditions in the ascending aorta and the following three branches. Coupled zero-dimensional WK models representing the distal vasculature were used to define the outlet boundary conditions under the abdomen. RESULTS Flow divisions of the main SG branches were 40.7% and 24.7%, respectively. Time-averaged wall shear stress and oscillatory shear index (OSI) increased at the junction connected the SG branch and the stent leading to the right common iliac artery (RCIA) where the stent migrated. The OSI and relative residence time (RRT) value in superior mesenteric artery increased notably after the migration, the RRT continuously increased following the reintervention. CONCLUSION Unbalanced flow, resulting in locally high-speed flow, high WSS and OSI might significantly affect stent stability. Results suggest that diameters and interconnection design of stents in complex cases should take the flow division into consideration and computational simulations might be considered as a tool for intervention protocol design.
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Affiliation(s)
- Yuqian Mei
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Wei Ma
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Rui Yang
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hai Yuan
- Department of Vascular Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yan Peng
- Beijing CapitalBio Technology Corporation, Beijing, China
| | - Muyang Wu
- Department of Health Science Newark, University of Delaware, Newark, Delaware, USA
| | - Zhangtao Chen
- Department of Biomedical Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Tianxin Gao
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
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He Y, Guo W, Xiong J, Liu J, Ge Y, Cao L, Wang X, Rong D, Jia S, Sun G, Zhang H, Jia X, Ma X, Liu X. Retrograde Branched Endovascular Repair as a Feasible Option to Treat Complex Aortic Aneurysm Using the Retrograde Branched Extension Limb Assembling Technique. J Vasc Interv Radiol 2019; 30:1956-1963.e1. [PMID: 31669088 DOI: 10.1016/j.jvir.2019.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To present the primary experiences in treating suprarenal aneurysms, juxtarenal aneurysms, thoracoabdominal aortic aneurysms, and aneurysms after dissection with hostile anatomical features using the retrograde branched extension limb assembling (REBEL) technique. MATERIALS AND METHODS The study included 23 consecutive patients undergoing total endovascular repair with the REBEL technique from August 2014 to January 2019. Twelve patients had abdominal aortic aneurysms (4 juxtarenal, 8 suprarenal), 6 had thoracoabdominal aortic aneurysms (type IV), and 5 had postdissection aneurysms. The patients were unsuitable for treatment with current off-the-shelf devices or required emergent repair. The evaluated outcomes were technical success, operative mortality, complication morbidity, late survival, endoleakage, and reintervention during follow-up. RESULTS Technical success rate was 100%. In total, 60 visceral vessels were targeted (38 renal arteries, 1 accessory renal artery, 14 superior arteries, and 7 celiac arteries). The mean follow-up period was 20.1 ± 15.1 months (range 2-56), and no aneurysm-related mortality occurred during follow-up. No occlusion of target vessels occurred. Two type II endoleaks and 1 stent migration occurred in 3 (13.0%) patients, and reinterventions were successfully performed. One patient (4.3%) died of myocardial infarction at 38 months. CONCLUSIONS The REBEL technique is a feasible option with acceptable results for complex aortic aneurysms. Long-term follow-up of a large sample size is needed to determine the efficacy and durability of this novel technique.
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Affiliation(s)
- Yuan He
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Wei Guo
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853.
| | - Jiang Xiong
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Jie Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Yangyang Ge
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Long Cao
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Xinhao Wang
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Dan Rong
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Senhao Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Guoyi Sun
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Hongpeng Zhang
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Xin Jia
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Xiaohui Ma
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
| | - Xiaoping Liu
- Department of Vascular Surgery, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing City, China 100853
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