Hemodynamic consequences of TEVAR with in situ double fenestrations of left carotid artery and left subclavian artery
Hemodynamic consequences of TEVAR with in situ double fenestrations of left carotid artery and left subclavian artery
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左颈动脉和左锁骨下动脉原位双开窗 TEVAR 的血流动力学后果
DOI：
10.1016/j.medengphy.2019.10.016
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发表时间：
2020-02-01
影响因子：
2.2
通讯作者：
Luo, Kun
中科院分区：
文献类型：
--
作者：
Qiao, Yonghui;Mao, Le;Luo, Kun
胸主动脉腔内修复术（TEVAR）后，原位开窗术（ISF）可保留主动脉主要分支。本研究旨在探讨双开窗ISF-TEVAR的血流动力学后果。2例主动脉夹层和动脉瘤患者分别接受ISF-TEVAR治疗，并采用开窗技术重建左颈动脉（LCA）和左锁骨下动脉（LSA）。血液被视为非牛顿流体，在主动脉出口处采用Windkessel模型。在两种术后模型中进行模拟，以分析双开窗支架对血流动力学的影响。左冠状动脉和左冠状动脉支架术后壁压较低，左冠状动脉支架突出段内外壁存在压差，血液在开窗支架周围流动时出现加速，主动脉弓处出现剪切变稀流变行为，识别易受血栓形成影响的区域，并且暴露于高相对停留时间的表面位于LSA支架之后的主动脉弓处。双开窗支架的存在对术后血流动力学有深远的影响，随访时应密切观察主动脉弓和重建的分支。(C)2019年IPEM。由爱思唯尔有限公司出版。保留所有权利。
The aortic major branches after thoracic endovascular aortic repair (TEVAR) could be preserved by in situ fenestration (ISF). This study aims to explore the hemodynamic consequences of ISF-TEVAR with double fenestrations. Two patients with aortic dissection and aneurysm, respectively, were treated by ISF-TEVAR and both the left carotid artery (LCA) and left subclavian artery (LSA) were reconstructed by fenestration technique. The blood was considered a non-Newtonian fluid and the Windkessel model was adopted at the aortic outlets. Simulations were performed in two postoperative models to analyze the effects of the double fenestration stents on the hemodynamics. The postoperative wall pressure of the LCA and LSA is relatively low and the pressure difference between the inner and outer walls of the protruding segment of the LSA stent is found. Acceleration occurs when blood flows around the fenestration stents and the shear-thinning rheological behavior is observed at the aortic arch. Moreover, regions susceptible to thrombosis are identified and the surface exposed to high relative residence time is located at the aortic arch after the LSA stent. The presence of the double fenestration stents has a profound impact on the postoperative hemodynamics, and the aortic arch and rebuilt branches should be closely watched during follow-up. (C) 2019 IPEM. Published by Elsevier Ltd. All rights reserved.