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Manenti A, Roncati L, Sorrentino L, Farinetti A, Borri M, Manco G, Coppi G, Mattioli AV, Gelmini R, Coppi F. Thoracic aortic pseudoaneurysm: Inside its pathophysiology. Vascular 2024:17085381241273314. [PMID: 39118321 DOI: 10.1177/17085381241273314] [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: 08/10/2024]
Abstract
OBJECTIVES Our aim was to investigate pathophysiology of pseudoaneurysm of the thoracic aorta, an acute or chronic pathology, respectively, secondary to blunt thoracic trauma and aortitis, or complicating a deep penetrating aortic ulcer, intraparietal hematoma, aortic aneurysm, and even aortic graft, often with atherosclerosis as a common background. METHODS Given the relative rarity of this disease, an "inductive" retrospective method made it possible to retrieve clinical, radiological, and histopathological elements, which were mutually compared and validated through a "deductive" process of reinterpretation. RESULTS We have identified three main structural constituents of this disease: a cavity, a single blood entry port, communicating with the aortic lumen, and a pseudocapsule. It is often caused by a chronic degenerative pathology of the intima and medial layers of the aorta, typically involving elastic fibers and smooth muscle cells, with possible intermediate stages of deep aortic ulcer or intraparietal hematoma. Otherwise, the acute onset may be secondary to acute aortitis or aortic injury. CONCLUSIONS Today, thanks to the current angiographic tools represented by 3-D high resolution multidetector CT and MRI angiography, the diagnosis of thoracic aortic pseudoaneurysm is easier, as well as its surgical indications.
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Affiliation(s)
- Antonio Manenti
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Luca Roncati
- Departments of Pathology, University of Modena and Reggio Emilia, Italy
| | - Lorena Sorrentino
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Alberto Farinetti
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Massimo Borri
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Giuseppe Manco
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Giovanni Coppi
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | | | - Roberta Gelmini
- Departments of Surgery, University of Modena and Reggio Emilia, Italy
| | - Francesca Coppi
- Departments of Cardiology, University of Modena and Reggio Emilia, Italy
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Yoon WJ, Mani K, Han SM, Lee CJ, Cho JS, Wanhainen A. Near-wall hemodynamic changes in subclavian artery perfusion induced by retrograde inner branched thoracic endograft implantation. JVS Vasc Sci 2023; 4:100116. [PMID: 37496886 PMCID: PMC10366580 DOI: 10.1016/j.jvssci.2023.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/05/2023] [Indexed: 07/28/2023] Open
Abstract
Objective Left subclavian artery (LSA)-branched endografts with retrograde inner branch configuration (thoracic branch endoprosthesis [TBE]) offer a complete endovascular solution when LSA preservation is required during zone 2 thoracic endovascular aortic repair. However, the hemodynamic consequences of the TBE have not been well-investigated. We compared near-wall hemodynamic parameters before and after the TBE implantation using computational fluid dynamic simulations. Methods Eleven patients who had undergone TBE implantation were included. Three-dimensional aortic arch geometries were constructed from the pre- and post-TBE implantation computed tomography images. The resulting 22 three-dimensional aortic arch geometries were then discretized into finite element meshes for computational fluid dynamic simulations. Inflow boundary conditions were prescribed using normal physiological pulsatile circulation. Outlet boundary conditions consisted of Windkessel models with previously published values. Blood flow, modeled as Newtonian fluid, simulations were performed with rigid wall assumptions using SimVascular's incompressible Navier-Stokes solver. We compared well-established hemodynamic descriptors: pressure, flow rate, time-averaged wall shear stress (TAWSS), the oscillatory shear index (OSI), and percent area with an OSI of >0.2. Data were presented on the stented portion of the LSA. Results TBE implantation was associated with a small decrease in peak LSA pressure (153 mm Hg; interquartile range [IQR], 151-154 mm Hg vs 159 mm Hg; IQR, 158-160 mm Hg; P = .005). No difference was observed in peak LSA flow rates before and after implantation: 40.4 cm3/ (IQR, 39.5-41.6 cm3/s) vs 41.3 cm3/s (IQR, 37.2-44.8 cm3/s; P = .59). There was a significant postimplantation increase in TAWSS (15.2 dynes/cm2 [IQR, 12.2-17.7 dynes/cm2] vs 6.2 dynes/cm2 [IQR, 5.7-10.3 dynes/cm2]; P = .003), leading to decreases in both the OSI (0.088 [IQR, 0.063 to -0.099] vs 0.1 [IQR, 0.096-0.16]; P = .03) and percentage of area with an OSI of >0.2 (10.4 [IQR, 5.8-15.8] vs 15.7 [IQR, 10.7-31.9]; P = .13). Neither LSA side branch angulation (median, 81°, IQR, 77°-109°) nor moderate compression (16%-58%) seemed to have an impact on the pressure, flow rate, TAWSS, or percentage of area with an OSI of >0.2 in the stented LSA. Conclusions The implantation of TBE produces modest hemodynamic disturbances that are unlikely to result in clinically relevant changes.
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Affiliation(s)
- William J. Yoon
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Sukgu M. Han
- Comprehensive Aortic Center, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Cheong J. Lee
- Division of Vascular Surgery, Department of Surgery, NorthShore University Health System, Evanston, IL
| | - Jae S. Cho
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
- Department of Surgical and perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Fatma K, Carine GC, Marine G, Philippe P, Valérie D. Numerical modeling of residual type B aortic dissection: longitudinal analysis of favorable and unfavorable evolution. Med Biol Eng Comput 2022; 60:769-783. [PMID: 35076858 DOI: 10.1007/s11517-021-02480-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
Residual type B aortic dissection was numerically investigated to highlight the contribution of biomechanical parameters to the pathology's evolution. Patient-specific geometries from cases involving both favorable and unfavorable evolution were modeled to assess their hemodynamic features. This original approach was supported by a longitudinal study confirming the association between morphological changes, hemodynamic features, adverse clinical outcomes, and CT-angioscan observations on the same patient. Comparing one patient with unfavorable evolution with one with favorable one, we identify potential biomechanical indicators predictive of unfavorable evolution: (i) a patent false lumen with a flow rate above 50% of inlet flow rate; (ii) high wall shear stress above 18 Pa at entry tears, and above 10 Pa at some regions of the false lumen wall; (iii) low time-averaged wall shear stress in distal false lumen below 0.5 Pa; (iv) vortical structure dynamics. Although these comparisons could only be conducted on 2 patients and need to be confirmed by a larger number of cases, our findings point to these hemodynamic markers as possible candidates for early evaluation of the pathology's evolution towards an unfavorable scenario. Graphical Abstract Correlation between hemodynamics index and thrombus initiation for unfavorable case. ET2 and ET3 are entry tear numbers 2 and 3 respectively. WSS is wall shear stress. TAWSS is time average shear stress.
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Affiliation(s)
- Khannous Fatma
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France
| | | | - Gaudry Marine
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France
- Aix Marseille Univ, APHM, Timone Hospital, Department of Vascular Surgery, Marseille, France
| | - Piquet Philippe
- Aix Marseille Univ, APHM, Timone Hospital, Department of Vascular Surgery, Marseille, France
| | - Deplano Valérie
- Aix Marseille Univ, CNRS, IRPHE-UMR7342, Ecole Centrale, Marseille, France.
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Yau P, Lipsitz EC, Friedmann P, Indes J, Aldailami H. Aortic Neck Dilatation Following Thoracic Endovascular Aortic Repair. Ann Vasc Surg 2021; 76:104-113. [PMID: 34004324 DOI: 10.1016/j.avsg.2021.05.001] [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: 02/26/2021] [Revised: 04/14/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Thoracic endovascular aortic repair (TEVAR) has become a mainstay of treatment for a variety of thoracic aortic pathologies. Expansion of the proximal aortic neck after endovascular repair of abdominal aortic aneurysms has been demonstrated; however, dilatation of the proximal aortic neck after TEVAR has not been well described. We sought to describe remodeling of the proximal neck following TEVAR. METHODS This is a retrospective, single institution review of patients who underwent TEVAR for thoracic aortic aneurysm (TAA) and dissection with aneurysmal degeneration from 2010 to 2019. Postoperative computed tomography scans were reviewed and aortic diameter was measured in orthogonal planes using 3-dimensional centerline reconstruction software. The primary outcome was change in aortic diameter at the proximal aortic neck as compared to the initial postoperative computed tomography scan. Clinical and operative data were analyzed to identify factors associated with significant neck dilatation. RESULTS Of 87 patients who underwent TEVAR during the study period, 30 met inclusion criteria. Median follow up was 20.5 months. Median age was 67 years, and 15 patients (50%) were female. The proximal aortic neck experienced an overall increase over time in aortic diameter. Five mm distal to the graft showed the greatest rate of expansion, with a median increase of 1.3, 2.9, and 6.2 mm at one year, two years, and three years, respectively. When comparing patients who had mean expansion at this location of >2.0 mm/year to patients who did not, a higher percentage had dissection pathology (81.8% vs. 31.6%, P = 0.008), had graft placement at aortic landing zone 2 (36.4% vs. 5.3%, P = 0.028), and were smokers (100% vs. 52.6%, P = 0.006). Higher percent oversizing was shown to be associated with significant aortic neck dilatation for true aneurysms only. CONCLUSIONS Aortic neck dilatation occurs over time for the majority of patients following TEVAR with the distal neck experiencing the highest rate of expansion. Dissection pathology, aortic landing zone 2, and smoking were found to be associated with a higher rate of neck dilatation.
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Affiliation(s)
- Patricia Yau
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY.
| | - Evan C Lipsitz
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx NY
| | - Jeffrey Indes
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
| | - Hasan Aldailami
- Division of Vascular and Endovascular Surgery, Montefiore Medical Center and The Albert Einstein College of Medicine, Bronx, NY
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Tortuosity of the Descending Thoracic Aorta in Patients with Aneurysm and Type B Dissection. World J Surg 2020; 44:1323-1330. [PMID: 31873803 DOI: 10.1007/s00268-019-05328-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. METHODS Retrospective case-control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG). 3Mensio Vascular software was used to analyze CTA scans and collect the following measurements; tortuosity index, curvature ratio and the maximum tortuosity of the DTA. The DTA was divided into four equal zones. The maximum tortuosity was divided into three groups: low (<30°), moderate (30°-60°) and high tortuosity (>60°). RESULTS Compared to the CG, tortuosity was more pronounced in the DG, and even more in the AG, evidenced by the tortuosity index (1.11 vs. 1.20 vs. 1.31; p < 0.001), curvature ratio (1.00 vs. 1.01 vs. 1.03; p < 0.001), maximum tortuosity in degrees (28.17 vs. 33.29 vs. 43.83; p < 0.001) and group of tortuosity (p < 0.001). The maximum tortuosity was further distal for the DG and AG, evidenced by the zone of maximum tortuosity (4A vs. 4B vs. 4B; p < 0.001). CONCLUSION This study shows that tortuosity in the DTA is more prominent in diseased aortas, especially in aneurysmal disease. This phenomenon needs to be taken into account during planning of TEVAR to prevent stent graft-related complications and to obtain positive long-term outcome.
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Costache VS, Meekel JP, Costache A, Melnic T, Solomon C, Chitic AM, Bucurenciu C, Moldovan H, Antoniac I, Candea G, Yeung KK. Geometric Analysis of Type B Aortic Dissections Shows Aortic Remodeling After Intervention Using Multilayer Stents. MATERIALS 2020; 13:ma13102274. [PMID: 32429089 PMCID: PMC7287707 DOI: 10.3390/ma13102274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/26/2022]
Abstract
Recently, multilayer stents for type B aortic dissections (TBAD) have been proposed to decrease false lumen flow, increase and streamline true lumen flow, and retain branch vessel patency. We aimed to provide a protocol with standardized techniques to investigate aortic remodeling of TBAD by multilayer flow modulators (MFM) in static geometric and hemodynamic analyses. Combining existing literature and new insights, a standardized protocol was designed. Using pre- and postoperative CT scans, geometric models were constructed, lumen dimensions were calculated, computational fluid dynamics (CFD) models were composed, and velocity and pressures were calculated. Sixteen TBAD cases treated with MFM were included for analysis. For each case, aortic remodeling was analyzed using post-processing medical imaging software. After 3D models were created, geometrical anatomical measurements were performed, and meshes for finite element analysis were generated. MFM cases were compared pre- and postoperatively; true lumen volumes increased (p < 0.001), false lumen volumes decreased (p = 0.001), true lumen diameter at the plane of maximum compression (PMC) increased (p < 0.001), and false lumen index decreased (p = 0.008). True lumen flow was streamlined, and the overall fluid velocity and pressures decreased (p < 0.001 and p = 0.006, respectively). This protocol provided a standardized method to evaluate the effects of MFM treatments in TBAD on geometric analyses, PMC, and CFD outcomes.
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Affiliation(s)
- Victor S. Costache
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Jorn P. Meekel
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
- Department of Vascular Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
- Surgery Department, Zaans Medisch Centrum, 1502 DV Zaandam, The Netherlands
| | - Andreea Costache
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
- Correspondence:
| | - Tatiana Melnic
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Crina Solomon
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Anca M. Chitic
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Cristian Bucurenciu
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Horatiu Moldovan
- Department of Cardiac Surgery, Titu Maiorescu University, 040441 Bucharest, Romania;
| | - Iulian Antoniac
- Materials Science and Engineering Faculty, University Politehnica of Bucharest, 060042 Bucharest, Romania;
| | - Gabriela Candea
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
| | - Kak K. Yeung
- NextCardio Project, Lucian Blaga University of Sibiu, 550024 Sibiu, Romania; (V.S.C.); (J.P.M.); (T.M.); (C.S.); (A.M.C.); (C.B.); (G.C.); (K.K.Y.)
- Department of Vascular Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands
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Belvroy VM, de Beaufort HW, van Herwaarden JA, Trimarchi S, Moll FL, Bismuth J. Type 1b Endoleaks After Thoracic Endovascular Aortic Repair are Inadequately Reported: A Systematic Review. Ann Vasc Surg 2020; 62:474-483. [DOI: 10.1016/j.avsg.2019.06.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022]
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Auricchio F, Conti M, Romarowski RM. Usefulness of computational fluid dynamics in penetrating aortic ulcer. Ann Cardiothorac Surg 2019; 8:492-493. [PMID: 31463213 DOI: 10.21037/acs.2019.06.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS-Policlinico San Donato, San Donato Milanese, Italy
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