Predicting the effect on pulse wave reflection of different endovascular repair techniques in abdominal aortic aneurysm using 1D patient-specific models
Predicting the effect on pulse wave reflection of different endovascular repair techniques in abdominal aortic aneurysm using 1D patient-specific models
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DOI：
10.1007/s12553-016-0140-8
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发表时间：
2016-11-01
影响因子：
2.5
通讯作者：
Armentano, R. L.
中科院分区：
文献类型：
--
作者：
Casciaro, M. E.;Alfonso, M. A.;Armentano, R. L.
腹主动脉瘤（AAA）是一种病理性扩张的腹主动脉，通常远至肾动脉。因此，微创血管内主动脉修复术已成为一种常见的技术，并在手术结果的表征方面做出了很大的努力，包括血管内移植物移位、渗漏、动脉瘤囊扩大或其他术后并发症。最近，两种新型装置（AFX和Nellix密封装置）被开发出来，以克服这些并发症，但没有研究说明它们可能对压力波形产生的影响。在这项研究中，我们解决了生成患者特定的主动脉瘤一维模型的问题，并计算了这些设备在波反射方面对压力的影响。结果，我们发现两种血管内修复装置都将反射波瞬变时间减少了一个数量级，并且与AFX相比，Nellix装置显示腹近端主动脉和肾动脉水平的反射波振幅增加（与未病变主动脉相比，振幅比分别增加33%和75%）。由于肾脏部位的压力和脉搏波形对整体心血管生理的重要性，这些结果的有效性应该仔细研究，以便开发针对患者的医疗干预计划工具。
Abdominal aortic aneurysm (AAA) is a pathological dilation of the abdominal aorta, generally distal to the renal arteries. In relation to this, minimally invasive endovascular aortic repair has become a common technique, and great efforts have been made to characterize surgical outcome in terms of endograft displacement, leakages, aneurysm sac enlargement or other post-operative complication. Recently, two novel devices (AFX and Nellix sealing device) were developed to surpass these complications, but there is no work accounting for the effects they may have on the pressure waveform. In this study, we address the problem of generating a patient-specific 1D model of an aortic aneurysm, and compute the impact that these devices can have on pressure, in terms of wave reflection. As a result, we found both endovascular repair devices decrease the reflected wave transient time by one order of magnitude, and that the Nellix device shows increased reflected wave amplitude at proximal abdominal aorta and at renal artery level compared to AFX (33 % and 75 % increase in amplitude ratio compared to a non-diseased aorta, respectively). Due to the importance that pressure at renal site and pulse waveform have on the overall cardiovascular physiology, the validity of these results should be carefully studied in order to develop a patient-specific tool for medical planning of interventions.