The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator.
The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator.
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TEVAR 术后封堵主动脉夹层再入撕裂的必要性：血流动力学指标
DOI：
10.3389/fbioe.2022.831903
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发表时间：
2022
影响因子：
5.7
通讯作者：
Chen, Duanduan
中科院分区：
文献类型：
--
作者：
Li, Zhenfeng;Xu, Huanming;Armour, Chloe Harriet;Guo, Yuze;Xiong, Jiang;Xu, Xiaoyun;Chen, Duanduan
胸主动脉腔内修复术（TEVAR）是斯坦福大学B型主动脉夹层（TBAD）的常用治疗方法。但是，在真假腔之间输送血液的支架植入区域远端可能会发现再进入撕裂。封闭折返性撕裂，尤其是胸壁撕裂，可进一步减少假腔的血液灌注;然而，这也可能带来再次介入或手术的风险。需要明智地确定是否有必要密封重返大气层的裂缝。在这项研究中，重建患者特定的TBAD模型，并建立了修改后的模型，几乎排除了胸部折返。计算血流动力学进行了研究，并报告了功能指数和第一平衡位置（FBP）的管腔压差的变化，由于密封的折返，。结果表明，通过无支架胸内再入口的净血流方向在不同病例中存在差异。排除具有朝向假腔的净流动的再进入可能导致FBP向远侧移动并且在假腔中的相对颗粒停留时间增加。本研究初步表明，再进入撕裂的血流动力学状态可以作为是否需要密封的指标。通过量化通过泪液的血流交换和FBP的移动，可以预测通过封闭胸廓返流的血流动力学受益，从而明智地确定进一步介入治疗的必要性。
Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management.
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