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Zhang X, Peng Y, Li G, Li J, Luo M, Che Y, Zheng L, Anzai H, Ohta M, Shu C. Elongation of the proximal descending thoracic aorta and associated hemodynamics increase the risk of acute type B aortic dissection. Technol Health Care 2024; 32:765-777. [PMID: 37545271 DOI: 10.3233/thc-230194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Acute type B aortic dissection (ATBAD) is a life-threatening aortic disease. However, little information is available on predicting and understanding of ATBAD. OBJECTIVE The study sought to explore the underlying mechanism of ATBAD by analyzing the morphological and hemodynamic characteristics related to aortic length. METHODS The length and tortuosity of the segment and the whole aorta in the ATBAD group (n= 163) and control group (n= 120) were measured. A fixed anatomic landmark from the distal of left subclavian artery (LSA) to the superior border of sixth thoracic vertebra was proposed as the proximal descending thoracic aorta (PDTA), and the dimensionless parameter, length ratio, was introduced to eliminate the individual differences. The significant morphological parameters were filtrated and the associations between parameters were investigated using statistical approaches. Furthermore, how aortic morphology influenced ATBAD was explored based on idealized aortic models and hemodynamic-related metrics. RESULTS The PDTA length was significantly increased in the ATBAD group compared with the control group and had a strong positive correlation with the whole aortic length (r= 0.89). The length ratio (LR2) and tortuosity (T2) of PDTA in the ATBAD group were significantly increased (0.15 ± 0.02 vs 0.12 ± 0.02 and 1.73 ± 0.48 vs 1.50 ± 0.36; P< 0.001), and LR2 was positive correlation with T2 (r= 0.73). In receiver-operating curve analysis, the area under the curve was 0.835 for LR2 and 0.641 for T2. Low and oscillatory shear (LOS) was positive correlation with LR2, and the elevated LOS occurred in the distal of LSA. CONCLUSION Elongation of PDTA is associated with ATBAD, and the length ratio is a novel predictor. Elongated PDTA induced more aggressive hemodynamic forces, and high LOS regions may correspond to the entry tear location. The synergy of the morphological variation and aggressive hemodynamics creates contributory conditions for ATBAD.
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Affiliation(s)
- Xuelan Zhang
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Yuan Peng
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Gaoyang Li
- Institute of Fluid Science, Tohoku University, Sendai, Japan
| | - Jiehua Li
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingyao Luo
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yue Che
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Liancun Zheng
- School of Mathematics and Physics, University of Science and Technology Beijing, Beijing, China
| | - Hitomi Anzai
- Institute of Fluid Science, Tohoku University, Sendai, Japan
| | - Makoto Ohta
- Institute of Fluid Science, Tohoku University, Sendai, Japan
| | - Chang Shu
- Department of Vascular Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
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2
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Wang J, Fan T, Zhang H, Ge Y, Lu W, Liu F, Rong D, Guo W. Aortic hemodynamic and morphological analysis before and after repair of thoracoabdominal aortic aneurysm using a G-Branch endograft. Front Physiol 2023; 14:1234989. [PMID: 37601633 PMCID: PMC10438984 DOI: 10.3389/fphys.2023.1234989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Background and objective: The G-Branch endograft is a novel multibranched "off-the-shelf" device used to repair thoracoabdominal aortic aneurysms (TAAAs). This report describes the hemodynamic and morphological performance of the G-Branch endograft in a human patient with TAAA. Materials and methods: We retrospectively reviewed the computed tomography angiography scans and clinical data of a woman in whom TAAA was treated using a G-Branch endograft. Patient-specific three-dimensional models were reconstructed, and computational fluid dynamics and morphological and hemodynamic indicators were analyzed before and after implantation of the device. Results: From a morphological perspective, there was an increase in cross-sectional area in the G-Branch endograft and all bridging stent grafts over time. Blood flow was redistributed among the renovisceral arteries, with a decrease in flow rate in the celiac artery and an increase in the left renal artery. Laminar blood flow was smoother and more rapid after implantation of the G-Branch device and remained stable during follow-up. In the bridging stent grafts, flow recirculation zones were found in the bridging zones of the celiac artery and superior mesenteric artery as well as the distal sealing zones of both renal arteries. Furthermore, higher time-averaged wall shear stress and a lower oscillatory index and relative resident time were found in the G-Branch endograft and bridging stent grafts. Quantitative analysis showed obvious reduction in the surface area ratio of the elevated time-averaged wall shear stress area and surface area ratio of the relative resident time after G-branch implantation. Conclusion: The revascularization of branch vessels occurred following G-branch implantation, with improvements arising not only from morphological changes but also from hemodynamic alterations. The long-term performance of the G-Branch endograft needs further investigation and clinical validation.
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Affiliation(s)
- Jiabin Wang
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Tingting Fan
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Hongpeng Zhang
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yangyang Ge
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Weihang Lu
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Feng Liu
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Dan Rong
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Wei Guo
- The First Medical Centre, Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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3
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Jagos J, Schwarz D, Polzer S, Bursa J. Effect of aortic bifurcation geometry on pressure and peak wall stress in abdominal aorta: Fluid-structure interaction study. Med Eng Phys 2023; 118:104014. [PMID: 37536835 DOI: 10.1016/j.medengphy.2023.104014] [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: 11/21/2022] [Revised: 05/03/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND OBJECTIVE Geometry of aorto-iliac bifurcation may affect pressure and wall stress in aorta and thus potentially serve as a predictor of abdominal aortic aneurysm (AAA), similarly to hypertension. METHODS Effect of aorto-iliac bifurcation geometry was investigated via parametric analysis based on two-way weakly coupled fluid-structure interaction simulations. The arterial wall was modelled as isotropic hyperelastic monolayer, and non-Newtonian behaviour was introduced for the fluid. Realistic boundary conditions of the pulsatile blood flow were used on the basis of experiments in literature and their time shift was tailored to the pulse wave velocity in the model to obtain physiological wave shapes. Eighteen idealized and one patient-specific geometries of human aortic tree with common iliac and renal arteries were considered with different angles between abdominal aorta (AA) and both iliac arteries and different area ratios (AR) of iliac and aortic luminal cross sections. RESULTS Peak wall stress (PWS) and systolic blood pressure (SBP) were insensitive to the aorto-iliac angles but sensitive to the AR: when AR decreased by 50%, the PWS and SBP increased by up to 18.4% and 18.8%, respectively. CONCLUSIONS Lower AR (as a result of the iliac stenosis or aging), rather than the aorto-iliac angles increases the BP in the AA and may be thus a risk factor for the AAA development.
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Affiliation(s)
- Jiri Jagos
- Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic.
| | - David Schwarz
- Department of Applied Mechanics, VSB-Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava-Poruba, Czech Republic
| | - Stanislav Polzer
- Department of Applied Mechanics, VSB-Technical University of Ostrava, 17. listopadu 2172/15, 708 00 Ostrava-Poruba, Czech Republic
| | - Jiri Bursa
- Faculty of Mechanical Engineering, Brno University of Technology, Technická 2896/2, 616 69 Brno, Czech Republic
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Fenelli C, Gargiulo M, Tsilimparis N. Reply. J Vasc Surg 2023; 77:316. [PMID: 36549797 DOI: 10.1016/j.jvs.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Cecilia Fenelli
- Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany; Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig-Maximilians University Hospital, Munich, Germany
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5
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Parker LP, Powell JT, Norman PE, Doyle BJ. What's going on in the left common iliac artery? J Vasc Surg 2023; 77:314-315. [PMID: 36549796 DOI: 10.1016/j.jvs.2022.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/09/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Louis P Parker
- FLOW & BioMEx, Department of Engineering Mechanics, Royal Institute of Technology (KTH), Stockholm, Sweden
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, United Kingdom
| | - Paul E Norman
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, Nedlands, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, Nedlands, WA, Australia; School of Engineering, The University of Western Australia, Perth, WA, Australia; Australian Research Council Centre for Personalised Therapeutics Technologies, Melbourne, VIC, Australia; BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom
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6
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Bonardelli S, Verzini F, Rivolta N, Pagliariccio G, Zanotti C, Boero M, Franchin M, Carbonari L, Baggi P, Gibello L, Parlani G, Cavi R, Piffaretti G. Long-term outcomes of endovascular aortic repair with flared iliac limb endografts in patients with abdominal aortic aneurysm and aneurysmal common iliac arteries. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:464-470. [PMID: 35238520 DOI: 10.23736/s0021-9509.22.12040-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the long-term outcomes of endovascular aneurysm repair with flared iliac limb grafts in patients with abdominal aortic aneurysm (AAA) and aneurysmal common iliac arteries (CIAs). METHODS This is a multicenter, retrospective, observational cohort study that involves four tertiary referral hospitals between May 1, 2005, and April 30, 2019. Primary outcomes were freedom from aneurysm-related mortality (ARM), and freedom from iliac-related reintervention. RESULTS We studied 995 aneurysmal iliac limbs in 795 (85.2%) patients who met the inclusion criteria. Median AAA diameter was 55mm (IQR: 51-60). Early mortality occurred in 3 (0.4%) patients. The median of follow-up time was 52 months (IQR: 26-88). Estimated freedom from ARM was 99±0.002% (95% CI: 99-99.9) at 1 year, and 99±0.004% (95% CI: 97.9-99.6) at 5-years. Chronic obstructive pulmonary disease (HR=6.4, 95% CI: 1.7-24.0, P=0.006), chronic kidney disease (HR=5.5, 95% CI: 1.4-21.9, P=0.016), and the presence of an aneurysmal left CIA (HR=5.3, 95% CI: 1.0.5-27.4, P=0.044) was associated with ARM. There were 42 (7.3%) late iliac-related events (limb occlusion, N.=5; iliac-related endoleaks, N.=37). Estimated freedom from iliac-related reintervention was 98±0.003% (95% CI: 97-99) at 1 year, and 95±0.01% (95% CI: 92.7-96.7) at 5-years, which was associated with an aneurysmal right CIA (HR=2.2, 95% CI: 1.3-3.9; P=0.005), and age ≥78 years (HR=1.9, 95% CI: 1.01-1.3; P=0.039). CONCLUSIONS EVAR flared iliac limb grafts showed a high rate of freedom from ARM and a low reintervention rate. Owing to these results, it can be a durable and stable alternative for patients aged >78 years.
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Affiliation(s)
- Stefano Bonardelli
- Unit of Vascular Surgery, Department of Surgical and Clinical Sciences, ASST Spedali Civili di Brescia, University of Brescia School of Medicine, Brescia, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Nicola Rivolta
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | | | - Camilla Zanotti
- Unit of Vascular Surgery, Department of Surgical and Clinical Sciences, ASST Spedali Civili di Brescia, University of Brescia School of Medicine, Brescia, Italy
| | - Michele Boero
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Marco Franchin
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
| | | | - Paolo Baggi
- Unit of Vascular Surgery, Department of Surgical and Clinical Sciences, ASST Spedali Civili di Brescia, University of Brescia School of Medicine, Brescia, Italy
| | - Lorenzo Gibello
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin School of Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Gianbattista Parlani
- Unit of Vascular and Endovascular Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Raffaella Cavi
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy
- ASST Settelaghi, Varese, Italy
| | - Gabriele Piffaretti
- Unit of Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, Varese, Italy -
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7
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Khinsoe G, Bappoo N, Kelsey LJ, Blom D, Doyle BJ, Jansen S. Computational biomechanics: a potential new tool for the vascular surgeon in personalized management. ANZ J Surg 2022; 92:1308-1311. [PMID: 35688636 DOI: 10.1111/ans.17476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/16/2021] [Accepted: 12/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Georgia Khinsoe
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Nikhilesh Bappoo
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia, Australia
| | - Dirk Blom
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.,Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Western Australia, Australia.,School of Engineering, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
| | - Shirley Jansen
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia.,Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, QEII Medical Centre, Perth, Western Australia, Australia.,Department of Vascular and Endovascular Surgery, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia
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8
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Imminent Rupture of Large Common Iliac Artery, Open Repair. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2022-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Arslan S, Sarıkaya Y. Aneurysm of the left ascending lumbar communicating vein: Its prevalence and possible association with nutcracker phenomenon. Clin Imaging 2022; 85:22-28. [DOI: 10.1016/j.clinimag.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 11/03/2022]
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10
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Parker LP, Svensson Marcial A, Brismar TB, Broman LM, Prahl Wittberg L. Impact of Altered Vena Cava Flow Rates on Right Atrium Flow Characteristics. J Appl Physiol (1985) 2022; 132:1167-1178. [PMID: 35271411 PMCID: PMC9054263 DOI: 10.1152/japplphysiol.00649.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The right atrium (RA) combines the superior (SVC) and inferior vena cava (IVC) flows. Treatments like extracorporeal membrane oxygenation (ECMO) and hemodialysis by catheter alter IVC/SVC flows. Here we assess how altered IVC/SVC flow contributions impact RA flow. Four healthy volunteers were imaged with CT, reconstructed and combined into a patient-averaged model. Large Eddy Simulations (LES) were performed for a range of IVC/SVC flow contributions (30-70% each, increments of 5%) and common flow metrics were recorded. Model sensitivity to reconstruction domain extent, constant/pulsatile inlets and hematocrit was also assessed. Consistent with literature, a single vortex occupied the central RA across all flowrates with a smaller counter-rotating vortex, not previously reported, in the auricle. Vena cava flow was highly helical. RA turbulent kinetic energy (TKE) (P=0.027) and time-averaged wall shear stress (WSS) (P<0.001) increased with SVC flow. WSS was lower in the auricle (2 Pa, P<0.001). WSS in the vena cava were equal at IVC/SVC =65/35%. The model was highly sensitive to the reconstruction domain with cropped geometries lacking helicity in the vena cavae, altering RA flow. RA flow was not significantly affected by constant inlets or hematocrit. The rotational flow conventionally described in the RA is confirmed however a new, smaller vortex was also recorded in the auricle. When IVC flow dominates, as is normal, TKE in the RA is reduced and WSS in the vena cavae equalize. Significant helicity exists in the vena cava, a result of distal geometry and this geometry appears crucial to accurately simulating RA flow.
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Affiliation(s)
- Louis P Parker
- FLOW and BioMEx, Department of Engineering Mechanics, Royal Institute of Technology, KTH, Stockholm, Sweden
| | - Anders Svensson Marcial
- Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Prahl Wittberg
- FLOW and BioMEx, Department of Engineering Mechanics, Royal Institute of Technology, KTH, Stockholm, Sweden
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11
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Bappoo N, Syed MBJ, Khinsoe G, Kelsey LJ, Forsythe RO, Powell JT, Hoskins PR, McBride OMB, Norman PE, Jansen S, Newby DE, Doyle BJ. Low Shear Stress at Baseline Predicts Expansion and Aneurysm-Related Events in Patients With Abdominal Aortic Aneurysm. Circ Cardiovasc Imaging 2021; 14:1112-1121. [PMID: 34875845 DOI: 10.1161/circimaging.121.013160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low shear stress has been implicated in abdominal aortic aneurysm (AAA) expansion and clinical events. We tested the hypothesis that low shear stress in AAA at baseline is a marker of expansion rate and future aneurysm-related events. METHODS Patients were imaged with computed tomography angiography at baseline and followed up every 6 months >24 months with ultrasound measurements of maximum diameter. From baseline computed tomography angiography, we reconstructed 3-dimensional models for automated computational fluid dynamics simulations and computed luminal shear stress. The primary composite end point was aneurysm repair and/or rupture, and the secondary end point was aneurysm expansion rate. RESULTS We included 295 patients with median AAA diameter of 49 mm (interquartile range, 43-54 mm) and median follow-up of 914 (interquartile range, 670-1112) days. There were 114 (39%) aneurysm-related events, with 13 AAA ruptures and 98 repairs (one rupture was repaired). Patients with low shear stress (<0.4 Pa) experienced a higher number of aneurysm-related events (44%) compared with medium (0.4-0.6 Pa; 27%) and high (>0.6 Pa; 29%) shear stress groups (P=0.010). This association was independent of known risk factors (adjusted hazard ratio, 1.72 [95% CI, 1.08-2.73]; P=0.023). Low shear stress was also independently associated with AAA expansion rate (β=+0.28 mm/y [95% CI, 0.02-0.53]; P=0.037). CONCLUSIONS We show for the first time that low shear stress (<0.4 Pa) at baseline is associated with both AAA expansion and future aneurysm-related events. Aneurysms within the lowest tertile of shear stress, versus those with higher shear stress, were more likely to rupture or reach thresholds for elective repair. Larger prospective validation trials are needed to confirm these findings and translate them into clinical management.
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Affiliation(s)
- Nikhilesh Bappoo
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research (N.B., G.K., L.J.K., P.E.N., B.J.D.), The University of Western Australia, Perth.,School of Engineering (N.B., G.K., L.J.K., B.K.D.), The University of Western Australia, Perth
| | - Maaz B J Syed
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, United Kingdom (M.B.J.S., R.O.F., P.R.H., O.M.B.M., D.E.N., B.J.D.)
| | - Georgia Khinsoe
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research (N.B., G.K., L.J.K., P.E.N., B.J.D.), The University of Western Australia, Perth.,School of Engineering (N.B., G.K., L.J.K., B.K.D.), The University of Western Australia, Perth
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research (N.B., G.K., L.J.K., P.E.N., B.J.D.), The University of Western Australia, Perth.,School of Engineering (N.B., G.K., L.J.K., B.K.D.), The University of Western Australia, Perth
| | - Rachael O Forsythe
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, United Kingdom (M.B.J.S., R.O.F., P.R.H., O.M.B.M., D.E.N., B.J.D.)
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, United Kingdom (J.T.P.)
| | - Peter R Hoskins
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, United Kingdom (M.B.J.S., R.O.F., P.R.H., O.M.B.M., D.E.N., B.J.D.).,Biomedical Engineering, Dundee University, United Kingdom (P.R.H.)
| | - Olivia M B McBride
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, United Kingdom (M.B.J.S., R.O.F., P.R.H., O.M.B.M., D.E.N., B.J.D.)
| | - Paul E Norman
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research (N.B., G.K., L.J.K., P.E.N., B.J.D.), The University of Western Australia, Perth.,Medical School (P.E.N., S.J.), The University of Western Australia, Perth
| | - Shirley Jansen
- Medical School (P.E.N., S.J.), The University of Western Australia, Perth.,Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Perth, Australia (S.J.).,Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Australia (S.J.).,Curtin Medical School, Curtin University, Perth, Australia (S.J.)
| | - David E Newby
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, United Kingdom (M.B.J.S., R.O.F., P.R.H., O.M.B.M., D.E.N., B.J.D.)
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research (N.B., G.K., L.J.K., P.E.N., B.J.D.), The University of Western Australia, Perth.,School of Engineering (N.B., G.K., L.J.K., B.K.D.), The University of Western Australia, Perth.,Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, United Kingdom (M.B.J.S., R.O.F., P.R.H., O.M.B.M., D.E.N., B.J.D.).,Australian Research Council Centre for Personalised Therapeutics Technologies (B.J.D.)
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Zhang X, Hao W, Han S, Ren CF, Yang L, Han Y, Gao B. Middle cerebral arterial bifurcation aneurysms are associated with bifurcation angle and high tortuosity. J Neuroradiol 2021; 49:392-397. [PMID: 34896148 DOI: 10.1016/j.neurad.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the association of middle cerebral artery (MCA) bifurcation aneurysms with bifurcation morphology. MATERIALS AND METHODS 205 patients were enrolled, including 61 patients with MCA bifurcation aneurysms and 144 non-aneurysmal subjects. Aneurysmal cases were divided into types C (aneurysm neck on extension of the parent artery centerline) and D (deviating neck). The radius of the parent artery M1 (RP) and bilateral branches (RS and RL, respectively), smaller (φS) and larger (φL) lateral angles, bifurcation angle, and arterial tortuosity from parent vessel to bilateral branches (TS and TL, respectively) were analyzed. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to identify risk factors and predictive values for MCA aneurysm presence and types. RESULTS In aneurysmal MCA bifurcations, bifurcating angle, TS, TL and RL were significantly larger (P<0.01), while φS was significantly smaller (P<0.001) than those in controls. The bifurcation angle, TS and LogitP were better morphological parameters for predicting MCA aneurysm presence with the AUC of 0.795, 0.932 and 0.951, respectively. Significant (P<0.05) differences were observed in the bifurcation angle, φL, RP, RL and TL between types C and D aneurysmal bifurcations. TL was an independent factor in discriminating types C from D aneurysms with an AUC of 0.802. CONCLUSIONS Bifurcation angle and arterial tortuosity from the parent artery to the branch forming a smaller angle with the parent artery have a higher value in distinguishing MCA aneurysmal from non-aneurysmal ones, and the tortuosity from the parent artery to the contralateral branch is the best indicator for distinguishing types C from D aneurysmal bifurcations.
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Affiliation(s)
- Xuejing Zhang
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | - Weili Hao
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | | | - Chun-Feng Ren
- Zhengzhou University First Affiliated Hospital, China
| | - Lei Yang
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | - Yongfeng Han
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China
| | - Bulang Gao
- Department of Medical Research and Neurosurgery, Shijiazhuang People's Hospital, China.
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13
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Parker LP, Reutersberg B, Syed MBJ, Munshi B, Richards S, Kelsey LJ, Sakalihasan N, Eckstein HH, Norman PE, Doyle BJ. Proximal False Lumen Thrombosis is Associated with Low False Lumen Pressure and Fewer Complications in Type B Aortic Dissection. J Vasc Surg 2021; 75:1181-1190.e5. [PMID: 34742883 DOI: 10.1016/j.jvs.2021.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Improved risk stratification is a key priority for type B aortic dissection (TBAD). Partial false lumen thrombus morphology is an emerging predictor of complications however, partial thrombosis is poorly defined and its evaluation in clinical studies is inconsistent. PURPOSE This work aims to characterise hemodynamic pressure in TBAD and determine how pressure relates to false lumen thrombus morphology and clinical events. METHODS Retrospective admission computed tomography angiography of 69 patients with acute TBAD was used to construct three-dimensional computational models for simulation of cyclical blood flow and calculation of pressure. Patients were categorised based on false lumen thrombus morphology: minimal; proximal; distal; or extensive thrombosis. Linear regression analysis compared the luminal pressure difference between the true and false lumen for each morphology group. The impact of morphology classification on acute complications within 14 days was studied using logistic regression adjusted for clinical parameters. A survival analysis for adverse aortic events at one-year was also performed using Cox regression. RESULTS 44 patients experienced acute complications and 45 had an adverse aortic event at one-year. Mean (±standard deviation) age was 62.6 (±12.6) years and 75.4% were male. Compared to patients with minimal thrombosis, those with proximal thrombosis had reduced false lumen pressure by 10.1mmHg (95% CI 4.3-15.9mmHg, p=.001). Individuals that did not experience an acute complication had reduced relative false lumen pressure (-6.35mmHg vs -0.62mmHg, p=.03). Proximal thrombosis was associated with fewer acute complications (OR 0.17, 95% CI 0.04-0.60 p=.01) and one-year adverse aortic events (HR 0.36, 95% CI 0.16-0.80, p=.01). CONCLUSIONS Proximal false lumen thrombosis is a marker of reduced false lumen pressure. This may explain how proximal false lumen thrombosis appears protective of acute complications (refractory hypertension or pain, aortic rupture, visceral or limb malperfusion and acute expansion) and adverse aortic events within the first year.
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Affiliation(s)
- Louis P Parker
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery and Munich Aortic Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department for Vascular Surgery, University Hospital of Zurich, Switzerland
| | - Maaz B J Syed
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, UK
| | - Bijit Munshi
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia; Medical School, The University of Western Australia, Australia
| | - Samantha Richards
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Natzi Sakalihasan
- Cardiovascular and Thoracic Surgery Department, Centre Hospitalier Universitaire de Liège, Belgium
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery and Munich Aortic Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Paul E Norman
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia; Medical School, The University of Western Australia, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and the UWA Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia; Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, UK; Cardiovascular and Thoracic Surgery Department, Centre Hospitalier Universitaire de Liège, Belgium.
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14
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Zhang L, Shu C, Li X. A Cause of Cardiac Failure: Common Iliac Artery Aneurysm- Inferior Vena Cava Fistula. Vasc Endovascular Surg 2021; 55:901-902. [PMID: 34261377 DOI: 10.1177/15385744211032635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, 70566The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, 70566The Second Xiangya Hospital, Central South University, Changsha, China.,Center of Vascular Surgery, Fuwai Hospital, 12501Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Li
- Department of Vascular Surgery, 70566The Second Xiangya Hospital, Central South University, Changsha, China
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15
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Lanzarone E, Finotello A, Pane B, Pratesi G, Palombo D, Conti M, Spinella G. Prediction model of isolated iliac and abdominal aneurysms. Eur J Clin Invest 2021; 51:e13517. [PMID: 33569787 DOI: 10.1111/eci.13517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We analyse the cardiovascular risk factors in patients undergoing screening for Isolated Iliac Aneurysm (IIA) and Abdominal Aortic Aneurysm (AAA) and propose a logistic regression model to indicate patients at risk of IIA and/or AAA. METHODS A screening programme was carried out to identify the presence of aneurysm based on Duplex scan examination. Cardiovascular risk factors information was collected from each subject. A descriptive analysis for the incidence of IIA and AAA stratified by age and sex was carried out to evaluate factors incidence. A logistic regression model was developed to predict the probability of developing an aneurysm based on the observed risk factor levels. A threshold probability of aneurysm risk for a datum patient was also identified to effectively direct screening protocols to patients most at risk. RESULTS A cohort of 10 842 patients was evaluated: 1.52% affected by IIA, 2.69% by AAA and 3.90% by at least one. Risk factors analysis showed that: IIA was correlated with cardiological status, diabetes, cardiovascular disease family history, and dyslipidaemia; AAA was correlated with cardiological status, body mass index, hypertension, and dyslipidaemia; diabetes and dyslipidaemia were the most relevant factors with at least one aneurysm. The prediction tool based on the logistic regression and the threshold probability predict the presence of IIA and AAA in 69.7% and 83.8% of cases, under k-fold cross-validation. CONCLUSIONS The proposed regression model can represent a valid aid to predict IIA and AAA presence and to select patients to be screened.
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Affiliation(s)
- Ettore Lanzarone
- Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy
| | - Alice Finotello
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Giovanni Spinella
- Vascular and Endovascular Surgery Unit, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy
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Nishimiya K, Matsumoto Y, Shimokawa H. Recent Advances in Vascular Imaging. Arterioscler Thromb Vasc Biol 2020; 40:e313-e321. [PMID: 33054393 DOI: 10.1161/atvbaha.120.313609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Recent advances in vascular imaging have enabled us to uncover the underlying mechanisms of vascular diseases both ex vivo and in vivo. In the past decade, efforts have been made to establish various methodologies for evaluation of atherosclerotic plaque progression and vascular inflammatory changes in addition to biomarkers and clinical manifestations. Several recent publications in Arteriosclerosis, Thrombosis, and Vascular Biology highlighted the essential roles of in vivo and ex vivo vascular imaging, including magnetic resonance image, computed tomography, positron emission tomography/scintigraphy, ultrasonography, intravascular ultrasound, and most recently, optical coherence tomography, all of which can be used in bench and clinical studies at relative ease. With new methods proposed in several landmark studies, these clinically available imaging modalities will be used in the near future. Moreover, future development of intravascular imaging modalities, such as optical coherence tomography-intravascular ultrasound, optical coherence tomography-near-infrared autofluorescence, polarized-sensitive optical coherence tomography, and micro-optical coherence tomography, are anticipated for better management of patients with cardiovascular disease. In this review article, we will overview recent advances in vascular imaging and ongoing works for future developments.
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Affiliation(s)
- Kensuke Nishimiya
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuharu Matsumoto
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- From the Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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17
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Lipp SN, Niedert EE, Cebull HL, Diorio TC, Ma JL, Rothenberger SM, Stevens Boster KA, Goergen CJ. Computational Hemodynamic Modeling of Arterial Aneurysms: A Mini-Review. Front Physiol 2020; 11:454. [PMID: 32477163 PMCID: PMC7235429 DOI: 10.3389/fphys.2020.00454] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/09/2020] [Indexed: 01/02/2023] Open
Abstract
Arterial aneurysms are pathological dilations of blood vessels, which can be of clinical concern due to thrombosis, dissection, or rupture. Aneurysms can form throughout the arterial system, including intracranial, thoracic, abdominal, visceral, peripheral, or coronary arteries. Currently, aneurysm diameter and expansion rates are the most commonly used metrics to assess rupture risk. Surgical or endovascular interventions are clinical treatment options, but are invasive and associated with risk for the patient. For aneurysms in locations where thrombosis is the primary concern, diameter is also used to determine the level of therapeutic anticoagulation, a treatment that increases the possibility of internal bleeding. Since simple diameter is often insufficient to reliably determine rupture and thrombosis risk, computational hemodynamic simulations are being developed to help assess when an intervention is warranted. Created from subject-specific data, computational models have the potential to be used to predict growth, dissection, rupture, and thrombus-formation risk based on hemodynamic parameters, including wall shear stress, oscillatory shear index, residence time, and anomalous blood flow patterns. Generally, endothelial damage and flow stagnation within aneurysms can lead to coagulation, inflammation, and the release of proteases, which alter extracellular matrix composition, increasing risk of rupture. In this review, we highlight recent work that investigates aneurysm geometry, model parameter assumptions, and other specific considerations that influence computational aneurysm simulations. By highlighting modeling validation and verification approaches, we hope to inspire future computational efforts aimed at improving our understanding of aneurysm pathology and treatment risk stratification.
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Affiliation(s)
- Sarah N Lipp
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Elizabeth E Niedert
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Hannah L Cebull
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Tyler C Diorio
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Jessica L Ma
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Sean M Rothenberger
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Kimberly A Stevens Boster
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States.,School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States
| | - Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
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18
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Parker LP, Powell JT, Kelsey LJ, Venermo M, Koncar I, Norman PE, Doyle BJ. Morphology and Computational Fluid Dynamics Support a Novel Classification of Common Iliac Aneurysms. Eur J Vasc Endovasc Surg 2020; 59:786-793. [PMID: 31982309 DOI: 10.1016/j.ejvs.2019.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/30/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Isolated common iliac artery aneurysms (CIAAs) are uncommon, and evidence concerning their development, progression, and management is weak. The objective was to describe the morphology and haemodynamics of isolated CIAAs in a retrospective study. METHODS Initially, a series of 25 isolated CIAAs (15 intact, 10 ruptured) in 23 patients were gathered from multiple centres, reconstructed from computed tomography, and then morphologically classified and analysed with computational fluid dynamics. The morphological classification was applied in a separate, consecutive cohort of 162 patients assessed for elective aorto-iliac intervention, in which 55 patients had intact CIAAs. RESULTS In the isolated CIAA cohort, three distinct morphologies were identified: complex (involving a bifurcation); fusiform; and kinked (distal to a sharp bend in the CIA), with mean diameters of 90.3, 48.3, and 31.7 mm, and mean time averaged wall shear stresses of 0.16, 0.31, and 0.71 Pa, respectively (both analysis of variance p values < .001). Kinked cases vs. fusiform cases had less thrombus and favourable haemodynamics similar to the non-aneurysmal contralateral common iliac artery (CIA). Ruptured isolated CIAAs were large (mean diameter 87.5 mm, range 55.5-138.0 mm) and predominantly complex. The mean CIA length for aneurysmal arteries was greatest in kinked cases followed by complex and fusiform (100.8 mm, 91.1 mm, and 80.6 mm, respectively). The morphological classification was readily applicable to a separate elective patient cohort. CONCLUSION A new morphological categorisation of CIAAs is proposed. Potentially this is associated with both haemodynamics and clinical course. Further research is required to determine whether the kinked CIAA is protected haemodynamically from aneurysm progression and to establish the wider applicability of the categorisation presented.
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Affiliation(s)
- Louis P Parker
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Janet T Powell
- Vascular Surgery Research Group, Imperial College London, London, UK
| | - Lachlan J Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia
| | - Maarit Venermo
- Division of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
| | - Paul E Norman
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; Medical School, The University of Western Australia, Perth, Australia
| | - Barry J Doyle
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Engineering, The University of Western Australia, Perth, Australia; Australian Research Council Centre for Personalised Therapeutics Technologies, Australia; BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK.
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19
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Morgan-Bates K, Dey R, Chaudhuri A. Ultrasound Assisted On-Table Management of Type III Endoleak at Endovascular Repair of Isolated Giant Common Iliac Aneurysm. EJVES Short Rep 2019; 45:17-21. [PMID: 31687476 PMCID: PMC6820109 DOI: 10.1016/j.ejvssr.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives This report presents the endovascular treatment of a large isolated common iliac artery aneurysm, focusing on the use of on table ultrasonography to characterise and treat an early endoleak that could not be defined by angiography alone. Report A 58 year old man presented with an asymptomatic, large (13cm) left common iliac artery aneurysm (LCIAA) whilst being investigated for change in bowel habit. This was treated successfully via a percutaneous approach using left internal iliac embolisation followed by endovascular aneurysm repair (EVAR) with deployment of an aorto-uni-iliac converter system from the LCIA origin to the external iliac artery. A non-characterised endoleak at the end of the procedure was shown to be a type IIIb endoleak by application of immediate on table ultrasonography, allowing immediate supplementary targeted stent graft deployment to cover the leaking segment. Discussion The patient was discharged uneventfully and will remain on follow up. On table ultrasonography allowed both localisation and characterisation of an immediate intra-procedural endoleak and confirmed cessation of the endoleak with supplementary stent grafting and thrombosis within the sac. Conclusions Isolated CIAA is rare, and endovascular therapy is appropriate for them, given that open surgery, whilst feasible, carries a high morbidity and mortality risk. Application of on-table ultrasound allows definition and targeted treatment of endoleaks, reducing the need for further intervention at a later stage, and thus also reducing the risk of continued pressurisation of the large sac post-EVAR till the next surveillance episode. Isolated common iliac artery aneurysms (CIAAs) are very rare. They can be asymptomatic but have a high risk of rupture. Open repair is high risk and associated with high morbidity/mortality. This paper highlights successful endovascular repair of a giant isolated CIAA. On table ultrasound helps immediately to characterise and treat endoleaks at EVAR.
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Affiliation(s)
- Kersten Morgan-Bates
- Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
| | - Ramita Dey
- Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
| | - A Chaudhuri
- Bedfordshire - Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Kempston Road, Bedford MK42 9DJ, UK
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