Computational Study of Fenestration and Parallel Grafts Used in Aortic Arch Lesion
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    Abstract:

    Objective This article aimed to explore the hemodynamics of the aortic arch and supraarch vessels after thoracic endovascular aortic repair with fenestration and parallel grafts techniques, and compare the differences of these techniques. Methods Four patients with aortic arch lesions whose supraarch vessels were reconstructed by different surgical techniques (fenestration, chimney and periscope) were studied, and 3D geometric models were established based on postoperative image data. The physiological flow obtained from 2D phase contrast magnetic resonance imaging were imposed on the ascending aorta inlet and the supraarch vessels outlets. The pressure waveform of three-element Windkessel model was imposed on the descending aorta outlet. Through computational fluid dynamics simulations, the hemodynamic parameters were obtained, including the pressure of supraarch vessels, the velocity vector of the stent inlet, and the relative residence time. Results The pressure change of the periscope stent was largest, followed by the fenestration stent, and the pressure change of the chimney stent was smallest. The velocity of the fenestration and periscope stent inlet was uneven, which may form vortex. The velocity of the chimney stent inlet was even. The high relative residence time concentrated in the distal end of the fenestration stent outer wall, the "gutter" part and the place where the chimney and periscope stent adhered to the vessel wall. Conclusions The pressure difference between the inner and outer walls of the fenestration and periscope stent was high, so it was recommended to use balloon-expandable stent. The pressure difference between the inner and outer walls of the chimney stent was low, so it was recommended to use self-expanding stent. The predicted location of thrombosis was consistent with the clinical follow-up data, so it may be used for surgical planning and risk assessment of interventional treatment of aortic arch lesions.

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History
  • Received:July 03,2022
  • Revised:July 23,2022
  • Adopted:July 29,2022
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