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Ong CW, Wee IJY, Toma M, Cui F, Xu XY, Richards AM, Leo HL, Choong AMTL. Haemodynamic changes in visceral hybrid repairs of type III and type V thoracoabdominal aortic aneurysms. Sci Rep 2023; 13:13760. [PMID: 37612440 PMCID: PMC10447573 DOI: 10.1038/s41598-023-40323-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
The visceral hybrid procedure combining retrograde visceral bypass grafting and completion endovascular stent grafting is a feasible alternative to conventional open surgical or wholly endovascular repairs of thoracoabdominal aneurysms (TAAA). However, the wide variability in visceral hybrid configurations means that a priori prediction of surgical outcome based on haemodynamic flow profiles such as velocity pattern and wall shear stress post repair remain challenging. We sought to appraise the clinical relevance of computational fluid dynamics (CFD) analyses in the setting of visceral hybrid TAAA repairs. Two patients, one with a type III and the other with a type V TAAA, underwent successful elective and emergency visceral hybrid repairs, respectively. Flow patterns and haemodynamic parameters were analysed using reconstructed pre- and post-operative CT scans. Both type III and type V TAAAs showed highly disturbed flow patterns with varying helicity values preoperatively within their respective aneurysms. Low time-averaged wall shear stress (TAWSS) and high endothelial cell action potential (ECAP) and relative residence time (RRT) associated with thrombogenic susceptibility was observed in the posterior aspect of both TAAAs preoperatively. Despite differing bypass configurations in the elective and emergency repairs, both treatment options appear to improve haemodynamic performance compared to preoperative study. However, we observed reduced TAWSS in the right iliac artery (portending a theoretical risk of future graft and possibly limb thrombosis), after the elective type III visceral hybrid repair, but not the emergency type V repair. We surmise that this difference may be attributed to the higher neo-bifurcation of the aortic stent graft in the type III as compared to the type V repair. Our results demonstrate that CFD can be used in complicated visceral hybrid repair to yield potentially actionable predictive insights with implications on surveillance and enhanced post-operative management, even in patients with complicated geometrical bypass configurations.
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Affiliation(s)
- Chi Wei Ong
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore, Singapore
| | - Ian J Y Wee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Milan Toma
- Department of Osteopathic Manipulative Medicine, College of Osteopathic Medicine, New York Institute of Technology, New York, USA
| | - Fangsen Cui
- Institute of High Performance Computing (IHPC), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, UK
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, New Zealand, New Zealand
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Andrew M T L Choong
- Division of Vascular and Endovascular Surgery, Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, Singapore, Singapore.
- Asian Aortic & Vascular Centre, Singapore, Singapore.
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